Predictive value of SOFA, PCT, Lactate, qSOFA and their combinations for mortality in patients with sepsis: A systematic review and meta-analysis

Abstract

Background Sepsis is a leading cause of death, necessitating early prediction of mortality risk. Objective 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. Methods According to PRISMA-DTA guidelines, PubMed, Embase, the Cochrane Library, and CNKI were searched (up to March 2025), and 29 studies were included (n = 41,469). 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 ΔAUROC was compared using a random-effects model based on a paired-data design. Heterogeneity was evaluated by I² (>50%) and Cochrane’s Q test. Results SOFA demonstrated superior predictive efficacy (AUROC = 0.819, 95% CI: 0.783–0.850; sensitivity = 0.77, 95% CI: 0.71–0.82; specificity = 0.73, 95% CI: 0.67–0.79), significantly outperforming PCT (ΔAUROC = 0.10, 95% CI: 0.04–0.16), lactate (ΔAUROC = 0.07, 95% CI: 0.03–0.11), and qSOFA (ΔAUROC = 0.08, 95% CI: 0.05–0.11). LqSOFA (AUROC = 0.823, 95% CI: 0.787–0.854) demonstrated efficacy comparable to SOFA (ΔAUROC = 0.02, 95% CI: −0.02–0.06) and significantly superior to qSOFA (ΔAUROC = 0.06, 95% CI: 0.04–0.08), with a sensitivity of 0.46 (0.24–0.69) and specificity of 0.88 (0.80–0.93). Subgroup analyses revealed sustained high performance in both emergency department (ED) settings (AUROC = 0.82, 95% CI: 0.79–0.85) and low- and middle-income countries (LMICs) (AUROC = 0.81, 95% CI: 0.77–0.84). Conclusion 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.