Sepsis prognosis in the emergency department: assessment of shock indices, SOFA, qSOFA, and lactate

BACKGROUND: The aim of this study was to compare the effectiveness of the shock index (SI), age shock index (ASI), modified shock index (MSI), and reverse shock index (RSI) in predicting prognosis in patients presenting to the emergency department with sepsis and septic shock with SOFA, qSOFA, and lactate levels. METHODS: This retrospective observational study included 203 patients (139 admitted to the ward, 64 admitted to the intensive care unit) who presented to the emergency medicine clinic of a city hospital with a diagnosis of sepsis or septic shock between 1 June 2020 and 1 June 2022. Patients' ward admission, intensive care admission, and one-month mortality outcomes were evaluated. The diagnostic performance of SI, ASI, MSI, RSI, SOFA, qSOFA, and lactate in predicting ICU admission, ward admission, and one-month mortality was assessed using age- and sex-adjusted univariate logistic regression analysis and ROC curve analysis (AUC). RESULTS: SOFA (AUC = 0.69, p < .001), lactate (AUC = 0.63, p = .001), and SI (AUC = 0.67, p < .001) were found to be significant in predicting ward admission. For intensive care admission, SOFA (AUC = 0.66, p = .001) and lactate (AUC = 0.63, p = .004) showed predictive value. Lactate was identified as the strongest predictor of one-month mortality (AUC = 0.74, p < .001), followed by SOFA (AUC = 0.68, p = .003) and qSOFA (AUC = 0.70, p = .033). CONCLUSION: Lactate level and SOFA score were found to be the most reliable prognostic markers in sepsis patients. Among shock indices, SI showed significant value in predicting hospital admission, while other shock indices had limited predictive value.