Comparative Prognostic Performance of qSOFA and SOFA in Emergency Department Patients With Established Septic Shock.

BACKGROUND: The quick sequential organ failure assessment (qSOFA) enables rapid bedside screening, whereas sequential organ failure assessment (SOFA) offers a more comprehensive evaluation of organ dysfunction; their comparative prognostic value in established septic shock remains unclear. OBJECTIVE: To compare the prognostic performance of qSOFA and SOFA for 28-day mortality prediction in patients with established septic shock according to Sepsis-3 criteria presenting to the emergency department and to evaluate the applicability of a simplified bedside scoring tool (qSOFA) within this specific high-risk population. METHODS: This retrospective cohort study included 486 patients with complete qSOFA and SOFA data from January 2021 to December 2024. Receiver operating characteristic curves, DeLong tests, multivariable logistic regression, Kaplan-Meier analysis, and calibration testing were performed. Multiple imputation of missing SOFA components was applied in a sensitivity analysis comprising 527 clinically eligible patients, and exploratory subgroup analyses were conducted according to infection source. RESULTS: The 28-day mortality rate was 38.5%. SOFA provided better mortality discrimination than qSOFA (AUC 0.847, 95% CI 0.812-0.882 vs. 0.724, 95% CI 0.679-0.769; p < 0.001) and also outperformed qSOFA in predicting ICU admission (AUC 0.798 vs. 0.686; p < 0.001). The SOFA score, age, and lactate level emerged as independent predictors of mortality. The addition of lactate improved qSOFA performance (AUC 0.789), and the findings remained robust in multiple-imputation and infection-source subgroup analyses. CONCLUSION: In patients with established septic shock according to Sepsis-3 criteria, SOFA outperformed qSOFA in mortality risk stratification. qSOFA may be useful for rapid bedside screening but should not replace the comprehensive prognostic assessment provided by SOFA.