{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:14:06Z","timestamp":1792458846126,"version":"4.5.0"},"reference-count":32,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u20130.74); NEWS: 0.71 (95% CI: 0.64\u20130.77); IEWS: 0.74 (95% CI: 0.68\u20130.80); IEWS_L: 0.81 (95% CI: 0.76\u20130.86). 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.<\/jats:p>","DOI":"10.3390\/jcm14144869","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T11:26:37Z","timestamp":1752233197000},"page":"4869","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["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"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5465-7479","authenticated-orcid":false,"given":"German Alberto","family":"Devia-Jaramillo","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Hospital Universitario Fundaci\u00f3n Santaf\u00e9 de Bogot\u00e1, Bogot\u00e1 110111, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilia","family":"Erazo-Guerrero","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital Universitario Fundaci\u00f3n Santaf\u00e9 de Bogot\u00e1, Bogot\u00e1 110111, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Laguado-Castro","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hospital Universitario Fundaci\u00f3n Santaf\u00e9 de Bogot\u00e1, Bogot\u00e1 110111, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Manuel","family":"Alfonso-Parada","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad del Rosario, Bogota 110111, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/S1473-3099(17)30322-5","article-title":"The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): An observational study","volume":"17","author":"Machado","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1097\/CCM.0b013e318218a35e","article-title":"The epidemiology of sepsis in Colombia: A prospective multicenter cohort study in ten university hospitals","volume":"39","author":"Barrera","year":"2011","journal-title":"Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2147\/OAEM.S289148","article-title":"USER Protocol as a Guide to Resuscitation of the Patient with Septic Shock in the Emergency Department. OAEM","volume":"13","year":"2021","journal-title":"Open Access Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.ccc.2016.12.004","article-title":"Severe Sepsis and Septic Shock Trials (ProCESS, ARISE, ProMISe): What is Optimal Resuscitation?","volume":"33","author":"Osborn","year":"2017","journal-title":"Crit. Care Clin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1056\/NEJMra1208623","article-title":"Severe sepsis and septic shock","volume":"369","author":"Angus","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Husab\u00f8, G., Nilsen, R.M., Flaatten, H., Sollig\u00e5rd, E., Frich, J.C., Bondevik, G.T., Braut, G.S., Walshe, K., Harthug, S., and Hovlid, E. (2020). Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227652"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.1742-6723.2010.01270.x","article-title":"Access block and ED overcrowding","volume":"22","author":"Forero","year":"2010","journal-title":"Emerg. Med. Australas."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2422823","DOI":"10.1001\/jamanetworkopen.2024.22823","article-title":"Sepsis Alert Systems, Mortality, and Adherence in Emergency Departments: A Systematic Review and Meta-Analysis","volume":"7","author":"Kim","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_10","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":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s13049-017-0449-y","article-title":"Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage","volume":"25","author":"Tusgul","year":"2017","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s13054-017-1658-5","article-title":"Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the intensive care unit","volume":"21","author":"Finkelsztein","year":"2017","journal-title":"Crit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1136\/emermed-2014-204465","article-title":"National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: A retrospective observational study","volume":"33","author":"Keep","year":"2016","journal-title":"Emerg. Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Wang, C., Xu, R., Zeng, Y., Zhao, Y., Hu, X., and Rostami, A. (2022). A comparison of qSOFA, SIRS and NEWS in predicting the accuracy of mortality in patients with suspected sepsis: A meta-analysis. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0266755"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1111\/jocn.17061","article-title":"Early warning scores for sepsis identification and prediction of in-hospital mortality in adults with sepsis: A systematic review and meta-analysis","volume":"33","author":"Chua","year":"2024","journal-title":"J. Clin. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2441","DOI":"10.1007\/s10096-024-04961-1","article-title":"Validation of MEWS, NEWS, NEWS-2 and qSOFA for different infection foci at the emergency department, the acutelines cohort","volume":"43","author":"Postma","year":"2024","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12245-024-00761-8","article-title":"Adjusting EWS scores for altitude above sea level: Is it necessary to predict sepsis mortality in the emergency room?","volume":"18","year":"2025","journal-title":"Int. J. Emerg. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1097\/CCM.0000000000005842","article-title":"Development and External Validation of the International Early Warning Score for Improved Age- and Sex-Adjusted In-Hospital Mortality Prediction in the Emergency Department","volume":"51","author":"Candel","year":"2023","journal-title":"Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/CCM.0000000000006135","article-title":"Surviving Sepsis Campaign Research Priorities 2023","volume":"52","author":"Deutschman","year":"2024","journal-title":"Crit. Care Med."},{"key":"ref_20","first-page":"171","article-title":"Overcrowding in emergency department: An international issue","volume":"10","author":"Paladino","year":"2014","journal-title":"Intern. Emerg. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2763","DOI":"10.2147\/IDR.S304952","article-title":"Prognostic Accuracy of SOFA, qSOFA, and SIRS for Mortality Among Emergency Department Patients with Infections","volume":"14","author":"Abdullah","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"289","DOI":"10.15441\/ceem.20.145","article-title":"A comparison of scoring systems for predicting mortality and sepsis in the emergency department patients with a suspected infection","volume":"8","author":"Thodphetch","year":"2021","journal-title":"Clin. Exp. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Brink, A., Alsma, J., Verdonschot, R.J.C.G., Rood, P.P.M., Zietse, R., Lingsma, H.F., Schuit, S.C.E., and Lopez-Delgado, J.C. (2019). Predicting mortality in patients with suspected sepsis at the Emergency Department; A retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0211133"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"619","DOI":"10.2147\/OAEM.S382752","article-title":"Predictive Performance of the NEWS\u2014Lactate and NEWS Towards Mortality or Need for Critical Care Among Patients with Suspicion of Sepsis in the Emergency Department: A Prospective Observational Study","volume":"14","author":"Dadeh","year":"2022","journal-title":"Open Access Emerg. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jcrc.2016.06.016","article-title":"Predictive value of the National Early Warning Score\u2013Lactate for mortality and the need for critical care among general emergency department patients","volume":"36","author":"Jo","year":"2016","journal-title":"J. Crit. Care"},{"key":"ref_26","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":"Qiu","year":"2023","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"PRISM Investigators, Rowan, K.M., Angus, D.C., Bailey, M., Barnato, A.E., Bellomo, R., Canter, R.R., Coats, T.J., Delaney, A., and Gimbel, E. (2017). Early, Goal-Directed Therapy for Septic Shock\u2014A Patient-Level Meta-Analysis. N. Engl. J. Med., 376, 2223\u20132234.","DOI":"10.1056\/NEJMoa1701380"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1007\/s00134-015-3822-1","article-title":"A systematic review and meta-analysis of early goal-directed therapy for septic shock: The ARISE, ProCESS and ProMISe Investigators","volume":"41","author":"Angus","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1186\/s13054-020-02950-2","article-title":"Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019\u2014Results from a systematic review and meta-analysis","volume":"24","author":"Bauer","year":"2020","journal-title":"Crit. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1164\/rccm.201504-0781OC","article-title":"Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations","volume":"193","author":"Fleischmann","year":"2016","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1001\/jama.2019.0071","article-title":"Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients with Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial","volume":"321","author":"Damiani","year":"2019","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1159\/000515851","article-title":"Quick Sequential Organ Failure Assessment, Sequential Organ Failure Assessment, and Procalcitonin for Early Diagnosis and Prediction of Death in Elderly Patients with Suspicion of Sepsis in the Emergency Department, Based on Sepsis-3 Definition","volume":"68","year":"2022","journal-title":"Gerontology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4869\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:07:08Z","timestamp":1760033228000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4869"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":32,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14144869"],"URL":"https:\/\/doi.org\/10.3390\/jcm14144869","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,9]]}}}