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. 2025 Jul 9;14(14):4869.
doi: 10.3390/jcm14144869.

Evaluating Sepsis Mortality Predictions from the Emergency Department: A Retrospective Cohort Study Comparing qSOFA, the National Early Warning Score, and the International Early Warning Score

German Alberto Devia-Jaramillo  1 , Lilia Erazo-Guerrero  1 , Vivian Laguado-Castro  1 , Juan Manuel Alfonso-Parada  2
Affiliations

Evaluating Sepsis Mortality Predictions from the Emergency Department: A Retrospective Cohort Study Comparing qSOFA, the National Early Warning Score, and the International Early Warning Score

German Alberto Devia-Jaramillo et al. J Clin Med. .

Abstract

Introduction: Sepsis has a high mortality rate, especially in low-income countries. Improving outcomes depends on the early recognition of patients at risk of death. Therefore, rapid and applicable prediction scores are needed in emergency triage. Objective: This study assessed the effectiveness of the qSOFA, NEWS, and IEWS scales in predicting in-hospital mortality during emergency triage. Additionally, we analyzed the efficacy of the IEWS_L, which integrates the IEWS with arterial lactate levels measured upon admission to the emergency department. Method: This retrospective study included patients who consulted the emergency department with suspected sepsis, where various scoring systems were evaluated for their effectiveness. We evaluated the diagnostic capacity of the tests by measuring the specificity, sensitivity, positive and negative predictive values, as well as the areas under the curve (AUC) of each score to predict mortality. Results: The study included 383 patients who had visited the emergency department. The overall mortality rate was 20.6%, and the mortality rate, precisely due to septic shock, was 35.2%. The AUC values for predicting in-hospital deaths due to sepsis were as follows: qSOFA: 0.68 (95% CI: 0.62-0.74); NEWS: 0.71 (95% CI: 0.64-0.77); IEWS: 0.74 (95% CI: 0.68-0.80); IEWS_L: 0.81 (95% CI: 0.76-0.86). Conclusions: In the emergency department, the IEWS scale demonstrated the best ability to accurately predict in-hospital mortality from sepsis when compared to the qSOFA and NEWS scale. Additionally, incorporating the serum lactate level into the IEWS scale significantly enhances its capacity to predict mortality.

Keywords: IEWS; NEWS; SOFA; Sepsis; diagnosis; mortality; qSOFA.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart for patient inclusion.
Figure 2
Figure 2
Receiver operating characteristic curves comparing prediction tools. qSOFA 0.68 (95% CI: 0.62–0.74); NEWS: 0.71 (95% CI:0.64–0.77); IEWS: 0.74 (95% CI:0.68–0.80); IEWS_L: 0.81 (95% CI:0.76–0.86).
Figure 3
Figure 3
Calibration curves of prediction scales: (A) qSOFA, (B) NEWS, (C) IEWS, (D) IEWS_L.
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