The utility of initial lactate for the quick sequential organ failure assessment (LqSOFA) for emergency septic patients

Abstract

Background

The Lactate-enhanced Quick Sequential Organ Failure Assessment (LqSOFA) has been identified as a tool for predicting sepsis outcomes. We evaluated the predictive power of the LqSOFA for adult patients suspected of having sepsis in the Emergency Department (ED). It was assessed as an indicator for Intensive Care Unit (ICU) admission, the necessity for vasopressors, and mortality within 72 h. This was then compared with the Quick Sequential Organ Failure Assessment (qSOFA).

Methods

We conducted a retrospective, cohort observational study of suspected sepsis patients from four branches of Dr. Sulaiman Al-Habib Medical Group (HMG) in Riyadh, Saudi Arabia, from 1 May 2022 to 30 April 2023. We calculated the initial LqSOFA and qSOFA for all patients. The sensitivity, specificity, and area under the receiver operator characteristic (AUROC) curve were evaluated for both LqSOFA and qSOFA scores (with ≥2 criteria) for each targeted outcome.

Results

The study included a total of 1274 patients, the majority of whom were males (754 (59.2 %)), with a mean age of 68.80 ± 17.9 years. LqSOFA demonstrated higher sensitivity for ICU admission, vasopressor requirement, and mortality (48 %, 68 %, and 76 % respectively) in comparison to qSOFA (30 %, 50 %, and 71 % respectively). However, the specificities of the LqSOFA score for ICU admission, vasopressor requirements, and mortality were lower (81 %, 71 %, and 67 % respectively) than those of the qSOFA score (89 %, 83 %, and 80 % respectively). The AUC of LqSOFA was greater than that of qSOFA for each outcome of interest but the difference was only statistically significant for mortality outcome (p-value <0.05).

Conclusion

LqSOFA exhibits strong predictive reliability compared to qSOFA. Prospective multiregional studies need to be conducted to validate LqSOFA's performance.