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Background <p>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.</p> Methods <p>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&#xa0;h, 7&#xa0;days, and 15&#xa0;days. Prognostic performance was evaluated using receiver operating characteristic curve analysis with 95% confidence intervals, and pairwise comparisons were conducted using DeLong’s test.</p> Results <p>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 (<i>p</i> &lt; 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 <i>p</i> &gt; 0.05).</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月18日

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  • Ali Unal,
  • Nese Colak,
  • Esra Deniz Goktepe,
  • Suleyman Gedik,
  • Abdulaziz Dogan

摘要

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.