Background: Sepsis screening in the emergency department (ED) is challenging. The quick Sequential Organ Failure Assessment (qSOFA) score had poor accuracy for predicting mortality in both the intensive care unit and ED. High lactate levels were associated with an increased mortality. However, a previous study using lactate levels in combination with the qSOFA score did not observe a meaningful improvement in predictive accuracy. This study assessed the prognostic accuracy of venous lactate levels plus the qSOFA (VqSOFA) score for predicting 28-day mortality. Methods: Patients who visited the Ramathibodi ED with suspected sepsis were enrolled. The VqSOFA, qSOFA, and Sequential Organ Failure Assessment (SOFA) scores were calculated using the initial vital signs and laboratory values. Prognostic accuracy was measured using the area under the receiver operating characteristic (AUROC) curve of the VqSOFA score and Sepsis-3 criteria for predicting 28-day mortality. Results: In total, 1,139 patients were enrolled, 118 of whom died within 28 days of admission. The AUROCs of the VqSOFA, qSOFA, and SOFA scores were 0.851 (95% CI 0.813-0.889), 0.813 (95% CI 0.772-0.854), and 0.728 (95% CI 0.671-0.784), respectively. Using VqSOFA score 3 as the cutoff, the sensitivity, specificity, and positive likelihood ratio were 74.6%, 82.5%, and 4.25%, respectively. VqSOFA 3 was linked to a low probability of 28-day survival and higher odds of vasopressor and ventilator use within 24 h. Conclusions: VqSOFA was more predictive of 28-day mortality and vasopressor and mechanical ventilator use than the qSOFA and SOFA scores. KEYWORDS-Lactate, mortality, qSOFA, sepsis, SOFA ABBREVIATIONS-AUROC-area under the receiver operating characteristic; CI-confidence internval; ED-emergency department; ICU-intensive care unit; IQR-interquartile range; qSOFA-quick Sequential Organ Failure Assessment; SD-standard deviation; SOFA-sequential organ failure assessment; VqSOFA-initial venous lactate level plus the qSOFA score Patient selection and the inclusion and exclusion criteriaThe patients 18 years and older who visited the Ramathibodi ED with suspected sepsis and underwent the Ramathibodi sepsis protocol from February 20, 2019, to February 19, 2020, identified by using software (RAMA-EMR) database, were enrolled. The exclusion criteria were as follows: infection by microbes other than bacteria such as viruses, submission of a donot-attempt resuscitation order, transfer to other hospitals, receipt of medical treatment at another hospital before arrival to our ED, and missing data.
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