{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:30:23Z","timestamp":1791822623103,"version":"4.3.4"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Science and Technology Program of Zhejiang Provincial Health Commission","award":["2021KY1016"],"award-info":[{"award-number":["2021KY1016"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Sepsis is a leading cause of death, necessitating early prediction of mortality risk.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To systematically review the predictive efficacy of the Sequential Organ Failure Assessment (SOFA), procalcitonin (PCT), lactate, quick Sequential Organ Failure Assessment (qSOFA), and lactate-adjusted qSOFA (LqSOFA) for the risk of death in patients with sepsis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>According to PRISMA-DTA guidelines, PubMed, Embase, the Cochrane Library, and CNKI were searched (up to March 2025), and 29 studies were included (n\u2009=\u200941,469). A bivariate random-effects model was used to pool the sensitivity, specificity, diagnostic odds ratio, and area under the receiver operating characteristic curve (AUROC). The \u0394AUROC was compared using a random-effects model based on a paired-data design. Heterogeneity was evaluated by I\u00b2 (&gt;50%) and Cochrane\u2019s Q test.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>SOFA demonstrated superior predictive efficacy (AUROC\u2009=\u20090.819, 95% CI: 0.783\u20130.850; sensitivity\u2009=\u20090.77, 95% CI: 0.71\u20130.82; specificity\u2009=\u20090.73, 95% CI: 0.67\u20130.79), significantly outperforming PCT (\u0394AUROC\u2009=\u20090.10, 95% CI: 0.04\u20130.16), lactate (\u0394AUROC\u2009=\u20090.07, 95% CI: 0.03\u20130.11), and qSOFA (\u0394AUROC\u2009=\u20090.08, 95% CI: 0.05\u20130.11). LqSOFA (AUROC\u2009=\u20090.823, 95% CI: 0.787\u20130.854) demonstrated efficacy comparable to SOFA (\u0394AUROC\u2009=\u20090.02, 95% CI: \u22120.02\u20130.06) and significantly superior to qSOFA (\u0394AUROC\u2009=\u20090.06, 95% CI: 0.04\u20130.08), with a sensitivity of 0.46 (0.24\u20130.69) and specificity of 0.88 (0.80\u20130.93). Subgroup analyses revealed sustained high performance in both emergency department (ED) settings (AUROC\u2009=\u20090.82, 95% CI: 0.79\u20130.85) and low- and middle-income countries (LMICs) (AUROC\u2009=\u20090.81, 95% CI: 0.77\u20130.84).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>SOFA remains the optimal predictor of sepsis mortality risk. qSOFA demonstrates suboptimal overall predictive ability, whereas LqSOFA achieves comparable accuracy to SOFA by combining the advantages of lactate and qSOFA. Its high specificity may be valuable for rapid risk exclusion in resource-limited settings (ED\/LMICs). Future studies should validate LqSOFA across diverse clinical settings and underrepresented LMIC regions and should integrate dynamic lactate clearance metrics.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0332525","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T17:30:56Z","timestamp":1758130256000},"page":"e0332525","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["Predictive value of SOFA, PCT, Lactate, qSOFA and their combinations for mortality in patients with sepsis: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"given":"Jinmei","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhouzhou","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longqiang","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2482-7777","authenticated-orcid":true,"given":"Zaixing","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"issue":"8","key":"pone.0332525.ref001","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"M Singer","year":"2016","journal-title":"JAMA"},{"issue":"10219","key":"pone.0332525.ref002","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0140-6736(19)33065-X","article-title":"A global accounting of sepsis","volume":"395","author":"JA Kempker","year":"2020","journal-title":"Lancet"},{"issue":"7","key":"pone.0332525.ref003","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine","volume":"22","author":"JL Vincent","year":"1996","journal-title":"Intensive Care Med"},{"issue":"5","key":"pone.0332525.ref004","doi-asserted-by":"crossref","first-page":"348","DOI":"10.5005\/jp-journals-10071-24462","article-title":"Serum procalcitonin vs SOFA score in predicting outcome in sepsis patients in medical intensive care unit","volume":"27","author":"VV Shinde","year":"2023","journal-title":"Indian J Crit Care Med"},{"key":"pone.0332525.ref005","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s40560-018-0279-7","article-title":"Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: a multinational multicenter prospective observational study","volume":"6","author":"KC Lie","year":"2018","journal-title":"J Intensive Care"},{"issue":"3","key":"pone.0332525.ref006","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.chest.2017.12.015","article-title":"A Comparison of the Quick-SOFA and Systemic Inflammatory Response Syndrome Criteria for the Diagnosis of Sepsis and Prediction of Mortality: A Systematic Review and Meta-Analysis","volume":"153","author":"R Serafim","year":"2018","journal-title":"Chest"},{"issue":"7","key":"pone.0332525.ref007","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1164\/rccm.201905-0917OC","article-title":"Predictive Accuracy of the Quick Sepsis-related Organ Failure Assessment Score in Brazil. A Prospective Multicenter Study","volume":"201","author":"FR Machado","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"21","key":"pone.0332525.ref008","doi-asserted-by":"crossref","first-page":"2202","DOI":"10.1001\/jama.2018.6229","article-title":"Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries","volume":"319","author":"KE Rudd","year":"2018","journal-title":"JAMA"},{"issue":"3","key":"pone.0332525.ref009","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1007\/s10156-008-0608-1","article-title":"Usefulness of procalcitonin serum level for the discrimination of severe sepsis from sepsis: a multicenter prospective study","volume":"14","author":"S Endo","year":"2008","journal-title":"J Infect Chemother"},{"issue":"3","key":"pone.0332525.ref010","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1097\/SHK.0b013e31815077ca","article-title":"Prognostic value of mortality in emergency department sepsis score, procalcitonin, and C-reactive protein in patients with sepsis at the emergency department","volume":"29","author":"C-C Lee","year":"2008","journal-title":"Shock"},{"issue":"3","key":"pone.0332525.ref011","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1097\/CCM.0000000000000742","article-title":"Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database","volume":"43","author":"B Casserly","year":"2015","journal-title":"Crit Care Med"},{"issue":"6","key":"pone.0332525.ref012","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1111\/1742-6723.12894","article-title":"Lactate \u22652 mmol\/L plus qSOFA improves utility over qSOFA alone in emergency department patients presenting with suspected sepsis","volume":"29","author":"A Shetty","year":"2017","journal-title":"Emerg Med Australas"},{"issue":"23","key":"pone.0332525.ref013","article-title":"Combining procalcitonin with the qSOFA and sepsis mortality prediction","volume":"98","author":"H Yu","year":"2019","journal-title":"Medicine (Baltimore)"},{"issue":"5","key":"pone.0332525.ref014","article-title":"The ability of an improved qSOFA score to predict acute sepsis severity and prognosis among adult patients","volume":"99","author":"Y Xia","year":"2020","journal-title":"Medicine (Baltimore)"},{"issue":"4","key":"pone.0332525.ref015","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1001\/jama.2017.19163","article-title":"Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement","volume":"319","author":"MDF McInnes","year":"2018","journal-title":"JAMA"},{"issue":"8","key":"pone.0332525.ref016","doi-asserted-by":"crossref","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"PF Whiting","year":"2011","journal-title":"Ann Intern Med"},{"issue":"10","key":"pone.0332525.ref017","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.jclinepi.2005.02.022","article-title":"Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews","volume":"58","author":"JB Reitsma","year":"2005","journal-title":"J Clin Epidemiol"},{"issue":"4","key":"pone.0332525.ref018","doi-asserted-by":"crossref","first-page":"607","DOI":"10.4103\/ijmr.IJMR_319_20","article-title":"Lactate enhanced-quick Sequential Organ Failure Assessment 2 (LqSOFA2): A new score for bedside prognostication of patients with sepsis","volume":"154","author":"MK Daga","year":"2021","journal-title":"Indian J Med Res"},{"issue":"4","key":"pone.0332525.ref019","doi-asserted-by":"crossref","first-page":"408","DOI":"10.37201\/req\/008.2023","article-title":"Ability of qSOFA1-lactate to predict 30-day mortality in patients seen for infection in the Emergency Department","volume":"36","author":"A Juli\u00e1n-Jim\u00e9nez","year":"2023","journal-title":"Rev Esp Quimioter"},{"issue":"1","key":"pone.0332525.ref020","doi-asserted-by":"crossref","first-page":"154","DOI":"10.5935\/0103-507X.20220010-en","article-title":"Prognostic value of hyperlactatemia in infected patients admitted to intensive care units: a multicenter study","volume":"34","author":"CM Silva","year":"2022","journal-title":"Rev Bras Ter Intensiva"},{"issue":"6","key":"pone.0332525.ref021","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1136\/emermed-2018-208361","article-title":"Prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA)-lactate criteria for mortality in adults with suspected bacterial infection in the emergency department of a hospital with limited resources","volume":"37","author":"R Sinto","year":"2020","journal-title":"Emerg Med J"},{"issue":"1","key":"pone.0332525.ref022","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1684\/ecn.2009.0185","article-title":"Prognostic value of inflammatory markers (notably cytokines and procalcitonin), nutritional assessment, and organ function in patients with sepsis","volume":"21","author":"M Su\u00e1rez-Santamar\u00eda","year":"2010","journal-title":"Eur Cytokine Netw"},{"issue":"3","key":"pone.0332525.ref023","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/SHK.0000000000001754","article-title":"Prognostic Accuracy of VqSOFA for Predicting 28-day Mortality in Patients with Suspected Sepsis in the Emergency Department","volume":"56","author":"K Suttapanit","year":"2021","journal-title":"Shock"},{"key":"pone.0332525.ref024","article-title":"Combined suPAR and qSOFA for the prediction of 28-day mortality in sepsis patients","year":"2021","journal-title":"SV"},{"issue":"9","key":"pone.0332525.ref025","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(22)00277-7","article-title":"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","volume":"10","author":"SW Wright","year":"2022","journal-title":"Lancet Glob Health"},{"issue":"4","key":"pone.0332525.ref026","first-page":"321","article-title":"Clinical value of serum endocan and procalcitonin in early diagnosis and prognosis evaluation of sepsis","volume":"29","author":"R Zhao","year":"2017","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"key":"pone.0332525.ref027","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.ajem.2025.02.042","article-title":"The utility of initial lactate for the quick sequential organ failure assessment (LqSOFA) for emergency septic patients","volume":"91","author":"SM Althunayyan","year":"2025","journal-title":"Am J Emerg Med"},{"issue":"5","key":"pone.0332525.ref028","first-page":"458","article-title":"Prognostic value of serum sodium variability within 72 hours and lactic acid combined with severity score in patients with sepsis","volume":"35","author":"H Chi","year":"2023","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"issue":"4","key":"pone.0332525.ref029","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1007\/s15010-022-01768-0","article-title":"A 2-year retrospective analysis of the prognostic value of MqSOFA compared to lactate, NEWS and qSOFA in patients with sepsis","volume":"50","author":"M Guarino","year":"2022","journal-title":"Infection"},{"issue":"3","key":"pone.0332525.ref030","first-page":"281","article-title":"Combined prognostic value of serum lactic acid, procalcitonin and severity score for short-term prognosis of septic shock patients","volume":"33","author":"C Hao","year":"2021","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"issue":"5","key":"pone.0332525.ref031","doi-asserted-by":"crossref","DOI":"10.5339\/jemtac.2022.29","article-title":"A two-year cross-sectional study on the impact of serial serum Lactate in comparison with APACHE IV and SOFA Scores in predicting outcomes in patients of sepsis at limited resources rural setup","volume":"2022","author":"P Jaiswal","year":"2022","journal-title":"Journal of Emergency Medicine, Trauma and Acute Care"},{"issue":"1","key":"pone.0332525.ref032","doi-asserted-by":"crossref","first-page":"40","DOI":"10.5152\/eurasianjmed.2021.20081","article-title":"Comparison of SOFA Score, SIRS, qSOFA, and qSOFA + L Criteria in the Diagnosis and Prognosis of Sepsis","volume":"53","author":"A Kilinc Toker","year":"2021","journal-title":"Eurasian J Med"},{"key":"pone.0332525.ref033","article-title":"Early Lactate\/Albumin and Procalcitonin\/Albumin Ratios as Predictors of 28-Day Mortality in ICU-Admitted Sepsis Patients: A Retrospective Cohort Study","volume":"29","author":"F Li","year":"2023","journal-title":"Med Sci Monit"},{"issue":"4","key":"pone.0332525.ref034","article-title":"The Combination of Systemic Immune-Inflammation Index and Serum Procalcitonin has High Auxiliary Predictive Value for Short-Term Adverse Prognosis in Septic Shock Patients","volume":"67","author":"L Li","year":"2024","journal-title":"J Emerg Med"},{"issue":"16","key":"pone.0332525.ref035","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.21037\/atm-20-5410","article-title":"Lactate-enhanced-qSOFA (LqSOFA) score is superior to the other four rapid scoring tools in predicting in-hospital mortality rate of the sepsis patients","volume":"8","author":"S Liu","year":"2020","journal-title":"Ann Transl Med"},{"issue":"1","key":"pone.0332525.ref036","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s13049-019-0609-3","article-title":"Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis","volume":"27","author":"Z Liu","year":"2019","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"2","key":"pone.0332525.ref037","doi-asserted-by":"crossref","first-page":"93","DOI":"10.5005\/jp-journals-10071-24404","article-title":"Blood Lactate Level and the Predictor of Death in Non-shock Septic Patients","volume":"27","author":"N Noparatkailas","year":"2023","journal-title":"Indian J Crit Care Med"},{"issue":"2","key":"pone.0332525.ref038","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1080\/13813455.2019.1677720","article-title":"Diagnostic and prognostic value of new bioscore in critically ill septic patients","volume":"128","author":"P Sen","year":"2022","journal-title":"Arch Physiol Biochem"},{"issue":"8","key":"pone.0332525.ref039","first-page":"704","article-title":"Analysis of death risk factors for nosocomial infection patients in an ICU: a retrospective review of 864 patients from 2009 to 2015","volume":"28","author":"J Wang","year":"2016","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"key":"pone.0332525.ref040","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajem.2023.12.028","article-title":"The usefulness of lactate\/albumin ratio, C-reactive protein\/albumin ratio, procalcitonin\/albumin ratio, SOFA, and qSOFA in predicting the prognosis of patients with sepsis who presented to EDs","volume":"78","author":"KH Yoo","year":"2024","journal-title":"Am J Emerg Med"},{"issue":"1","key":"pone.0332525.ref041","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1177\/0300060518793791","article-title":"Diagnostic and predictive performance of biomarkers in patients with sepsis in an intensive care unit","volume":"47","author":"Y Zhang","year":"2019","journal-title":"J Int Med Res"},{"key":"pone.0332525.ref042","doi-asserted-by":"crossref","first-page":"7979353","DOI":"10.1155\/2020\/7979353","article-title":"Prognostic Prediction Value of qSOFA, SOFA, and Admission Lactate in Septic Patients with Community-Acquired Pneumonia in Emergency Department","volume":"2020","author":"H Zhou","year":"2020","journal-title":"Emerg Med Int"},{"issue":"8","key":"pone.0332525.ref043","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1080\/14787210.2023.2237192","article-title":"SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis","volume":"21","author":"X Qiu","year":"2023","journal-title":"Expert Rev Anti Infect Ther"},{"issue":"1","key":"pone.0332525.ref044","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s00068-024-02757-8","article-title":"Lactate-enhanced-qSOFA (LqSOFA) score as a predictor of in-hospital mortality in patients with sepsis: systematic review and meta-analysis","volume":"51","author":"D Moncada-Guti\u00e9rrez","year":"2025","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"3","key":"pone.0332525.ref045","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/SHK.0000000000000205","article-title":"Association between hemodynamic presentation and outcome in sepsis patients","volume":"42","author":"SY Hwang","year":"2014","journal-title":"Shock"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0332525","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T17:31:05Z","timestamp":1758130265000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0332525"}},"subtitle":[],"editor":[{"given":"Inge","family":"Roggen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,17]]},"references-count":45,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0332525","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,17]]}}}