Predictive Performance of Lactate-Integrated Early Warning Scores in Non-Traumatic Critically Ill Adults: A Prospective Study

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ÜNAL A., Colak N., Goktepe E. D., Gedik S., Dogan A.

Bratislava Medical Journal, 2026 (SCI-Expanded, Scopus) identifier

  • Yayın Türü: Makale / Tam Makale
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1007/s44411-026-00610-5
  • Dergi Adı: Bratislava Medical Journal
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Anahtar Kelimeler: Emergency service, hospital, Intensive care units, Lactates, Mortality, Severity of illness index
  • Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
  • Uşak Üniversitesi Adresli: Evet

Özet

Background: Early prediction of morbidity and mortality in non-traumatic critically ill adults requiring intensive care unit (ICU)-level care is essential for timely intervention and resource utilization. This study evaluated the prognostic performance of lactate-integrated early warning scores—Modified Rapid Emergency Medicine Score-Lactate (mREMS-L) and National Early Warning Score-Lactate (NEWS-L)—compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) and admission serum lactate. Methods: This prospective observational study included 178 non-traumatic critically ill adults requiring ICU-level care. Demographic data, physiological variables, and scoring values were recorded at presentation. Outcomes were early clinical deterioration before ICU admission and all-cause mortality at 48 h, 7 days, and 15 days. Prognostic performance was evaluated using receiver operating characteristic curve analysis with 95% confidence intervals, and pairwise comparisons were conducted using DeLong’s test. Results: Early clinical deterioration occurred in 33.1% of patients (n = 59), and 15-day mortality was 29.8% (n = 53). NEWS-L demonstrated the highest discriminative performance for early clinical deterioration (AUC = 0.875) and significantly greater discrimination than the other scoring systems (p < 0.05). For 48-h, 7-day, and 15-day mortality, mREMS-L yielded the highest numerical AUC values (0.832, 0.789, and 0.792, respectively). However, no statistically significant differences were observed among the evaluated scoring systems for mortality outcomes (all p > 0.05). Conclusion: Lactate-integrated early warning scores provide comparable prognostic value in non-traumatic critically ill adults requiring ICU care. NEWS-L showed higher discriminative performance for predicting early clinical deterioration, while mREMS-L shows higher numerical discrimination for short-term mortality, without statistically superior performance among scores.