Combining qSOFA criteria with initial lactate levels: Improved screening of septic patients for critical illness

Objective: To determine if the addition of lactate to Quick Sequential Organ Failure Assessment (qSOFA) scoring improves emergency department (ED) screening of septic patients for critical illness. Methods: This was a multicenter retrospective cohort study of consecutive adult patients admitted to the hospital from the ED with infectious disease-related illnesses. We recorded qSOFA criteria and initial lactate levels in the first 6 h of ED stay. Our primary outcome was a composite of hospital death, vasopressor use, and intensive care unit stay <= 72 h of presentation. Diagnostic test characteristics were determined for: 1) lactate levels >= 2 and >= 4; 2) qSOFA scores >= 1, >= 2, and =3; and 3) combinations of these. Results: Of 3743 patients, 2584 had a lactate drawn 6 h of ED stay and 18% met the primary outcome. The qSOFA scores were >= 1, >= 2, and =3 in 59.2%, 22.0%, and 5.3% of patients, respectively, and 34.4% had a lactate level >= 2 and 7.9% had a lactate level >= 4. The combination of qSOFA >= 1 OR Lactate >= 2 had the highest sensitivity, 94.0% (95% CI: 91.3-95.9), Conclusions: The combination of OM >= 1 OR Lactate >= 2 provides substantially improved sensitivity for the screening of critical illness compared to isolated lactate and qSOFA thresholds. (C) 2019 Elsevier Inc All rights reserved.