Enhanced bedside mortality prediction combining point-of-care lactate and the quick Sequential Organ Failure Assessment (qSOFA) score in patients hospitalised with suspected infection in southeast Asia: a cohort study

Background Simple, bedside prediction of infection-related mortality in low-resource settings is crucial for triage and resource-utilisation decisions. We aimed to evaluate mortality prediction by combining point-of-care venous lactate with the quick Sequential Organ Failure Assessment (qSOFA) score in adult patients admitted to hospital with suspected infection in southeast Asia. Methods We performed a cohort study by prospectively enrolling patients aged 18 years or older who had been admitted to hospital within the previous 24 h for suspected infection (with at least three documented systemic manifestations of infection according to the 2012 Surviving Sepsis Campaign) at Sunpasitthiprasong Hospital in Ubon Ratchathani, Thailand (derivation cohort). Venous lactate concentration was determined by a point-of-care device and multiple scores were developed. We then evaluated candidate 28-day mortality prediction models combining qSOFA and the lactate scores. A final model was compared with the qSOFA score, a lactate score, and a modified Sequential Organ Failure Assessment (SOFA) score for mortality discrimination using the area under the receiver operating characteristic curve (AUROC). Mortality discrimination of the qSOFA-lactate score was then verified in an external, prospectively enrolled, multinational cohort in southeast Asia. Findings Between March 1,2013, and Jan 26, 2017,5001 patients were enrolled in the derivation cohort; 4980 had point-of-care lactate data available and were eligible for analysis, and 816 died within 28 days of enrolment. The discrimination for 28-day mortality prediction of a qS0FA-lactate score combining the qS0FA score and a lactate score was superior to that of the qS0FA score alone (AUROC 0.78 [95% CI 0.76-0-80] vs 0.68 [0.67-0.70]; p<0.0001) and similar to a modified SOFA score (0.77 [0.75-0.78]; p=0.088). A lactate score alone had superior discrimination compared with the qS0FA score (AUROC 0.76 [95% CI 0.74-0.78]; p<0.0001). 815 patients were enrolled in the external validation cohort and 792 had point-of-care lactate data and were included in the analysis; the qS0FA-lactate score (AUROC 0.77 [95% CI 0.73-0.82]) showed significantly improved 28-day mortality discrimination compared with the qSOFA score alone (0.69 [0.63-0.74]; p<0.0001). Interpretation In southeast Asia, rapid, bedside assessments based on point-of-care lactate concentration combined with the qSOFA score can identify patients at risk of sepsis-related mortality with greater accuracy than the qSOFA score alone, and with similar accuracy to a modified SOFA score. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Automated summary

In low-resource settings, combining point-of-care venous lactate with the quick Sequential Organ Failure Assessment (qSOFA) score can accurately identify patients at risk of sepsis-related mortality in Southeast Asia, with similar accuracy to a modified Sequential Organ Failure Assessment (SOFA) score.