Comparative Prognostic Performance of qSOFA and SOFA in Emergency Department Patients With Established Septic Shock

The quick sequential organ failure assessment (qSOFA) enables rapid bedside screening, whereas sequential organ failure assessment (SOFA) offers a more comprehensive evaluation of organ dysfunction; their comparative prognostic value in established septic shock remains unclear.

To compare the prognostic performance of qSOFA and SOFA for 28-day mortality prediction in patients with established septic shock according to Sepsis-3 criteria presenting to the emergency department and to evaluate the applicability of a simplified bedside scoring tool (qSOFA) within this specific high-risk population.

This retrospective cohort study included 486 patients with complete qSOFA and SOFA data from January 2021 to December 2024. Receiver operating characteristic curves, DeLong tests, multivariable logistic regression, Kaplan-Meier analysis, and calibration testing were performed. Multiple imputation of missing SOFA components was applied in a sensitivity analysis comprising 527 clinically eligible patients, and exploratory subgroup analyses were conducted according to infection source.

The 28-day mortality rate was 38.5%. SOFA provided better mortality discrimination than qSOFA (AUC 0.847, 95% CI 0.812-0.882 vs. 0.724, 95% CI 0.679-0.769; p < 0.001) and also outperformed qSOFA in predicting ICU admission (AUC 0.798 vs. 0.686; p < 0.001). The SOFA score, age, and lactate level emerged as independent predictors of mortality. The addition of lactate improved qSOFA performance (AUC 0.789), and the findings remained robust in multiple-imputation and infection-source subgroup analyses.

In patients with established septic shock according to Sepsis-3 criteria, SOFA outperformed qSOFA in mortality risk stratification. qSOFA may be useful for rapid bedside screening but should not replace the comprehensive prognostic assessment provided by SOFA.