Efeito prognóstico da associação do lactato sérico ao escore SOFA: SOFA-Lac

Abstract

This retrospective observational study evaluated a cohort of adult patients admitted to the general ICU of HUCFF/UFRJ between January 2023 and March 2024. Serum lactate levels obtained within the first 12 hours of admission were analyzed. A lactate score (0–4 points) was developed based on sample quintiles and added to the admission SOFA score to generate the SOFA-Lac. Prognostic performance for ICU mortality was assessed using Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) for the overall population, as well as for septic, medical, and surgical subgroups. A total of 337 patients were included (median age 64 years; 49% female). ICU mortality was 33% in the overall cohort and 71% among septic patients. Median serum lactate was 1.6 (1.0–3.2) mmol/L, median SOFA was 4 (1–9), and median SOFA-Lac was 7 (3–11). In the overall population, AUCs for mortality were 0.812 for SOFA, 0.557 for lactate, and 0.800 for SOFA-Lac. Among septic patients, SOFA-Lac achieved an AUC of 0.671 (68% accuracy) compared to 0.643 (64% accuracy) for SOFA alone. In medical patients, SOFA-Lac showed an AUC of 0.667 (65% accuracy) versus 0.646 (64% accuracy) for SOFA. Conversely, in surgical patients, SOFA predicted mortality with higher accuracy (79%) compared to SOFA-Lac (70%). Conclusion: Although SOFA-Lac demonstrated improved accuracy over SOFA and isolated lactate in predicting mortality among septic and medical patients, it did not outperform the isolated SOFA score in the overall population or in surgical patients.