Sepsis is a life-threatening clinical syndrome resulting from a dysregulated immune response to infection, leading to acute organ dysfunction and high mortality worldwide. The Global Burden of Disease Study estimated that in 2017 alone, approximately 49 million individuals developed sepsis, resulting in 11 million deaths representing nearly 20% of all global deaths [1]. Despite improvements in antimicrobial therapy, intensive care support and clinical guidelines, sepsis continues to challenge clinicians due to its heterogeneous presentation and rapid progression [2]. In response to these challenges, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) emphasized the use of organ dysfunction scores, partICUlarly the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA), for early recognition and risk stratification [3].

Various prognostic scoring tools such as the Modified Early Warning Score (MEWS), SOFAand qSOFA have been extensively studied for predicting outcomes in sepsis, with mixed results depending on the clinical setting [4,5]. Biomarkers like serum lactate, procalcitonin and C-reactive protein are frequently used in conjunction with clinical assessment to guide diagnosis and treatment [6,7]. However, in resource-constrained settings such as many Indian ICUs, challenges like delayed recognition, inadequate monitoring and workforce shortages contribute to suboptimal outcomes [8]. This study aims to assess the clinical profile, risk factors and outcomes of sepsis patients admitted to the medical ICU in a tertiary care center, with the goal of identifying key predictors of morbidity and mortality to guide future interventions.

This study was conducted as a hospital-based observational cross-sectional study in the Department of Internal Medicine at a tertiary care teaching hospital in India. The primary aim was to evaluate the clinical profile, associated risk factorsand outcomes of patients diagnosed with sepsis and admitted to the medical intensive care unit (ICU). The study was carried out over a period of 18 months, from June 2021 to December 2022, after obtaining ethical clearance from the Institutional Ethics Committee. Patients aged 18 years and above who were diagnosed with sepsis based on the Sepsis-3 criteria defined as suspected or confirmed infection with an increase in the Sequential Organ Failure Assessment (SOFA) score of ≥2 points were included in the study. Patients with terminal illnesses, recent major trauma or those who did not consent were excluded. Clinical data were collected at the time of ICU admission and throughout the hospital stay through a combination of clinical examination, patient records and laboratory investigations.

Vital signs, Glasgow Coma Scale (GCS) and findings from systemic examinations were documented. Laboratory parameters included complete blood count, renal and liver function tests, arterial blood gases, serum lactate levels and microbial cultures. Scoring tools such as SOFA, quick SOFA (qSOFA) and Modified Early Warning Score (MEWS) were calculated on admission. The primary outcomes of interest were in-hospital mortality and ICU length of stay, while secondary outcomes included the need for mechanical ventilation, vasopressor use and total hospital stay. Data were compiled using Microsoft Excel and analyzed with IBM SPSS Statistics version 26.0. Continuous variables were expressed as mean ±standard deviation (SD), while categorical variables were summarized using frequencies and percentages. Intergroup comparisons were made using the independent t-test for continuous variables and Chi-square test for categorical variables. A p-value < 0.05 was considered statistically significant.

The demographic and clinical distribution of the 130 sepsis patients in this study revealed that the majority were in the middle-aged to elderly categories, with 31.5% between 51–60 years, followed by 26.2% in the 41–50 age group and 20% in the 61–70 range. Only 8.5% of patients were aged 18–40, indicating that sepsis predominantly affected older adults. Males comprised 55.4% of the study population, slightly outnumbering females 44.6%. Urinary tract infection (UTI) was the most common identified source of infection, accounting for 20.8% of cases, followed by pulmonary infections 18.5% and skin and soft tissue infections 13.8%. Intra-abdominal and intestinal infections each accounted for 9.2% of cases, while 13.8% of infections were of unknown origin. Biliary 6.2%, bone 3.8% and other sites 4.6% were less commonly reported sources. Among co-morbid conditions, diabetes was the most prevalent 31.5%, followed by hypertension 19.2% and immunocompromised states 19.2%. Chronic obstructive pulmonary disease (COPD) was present in 14.6% of patients andliver cirrhosis in 10%. Congestive cardiac failure (CCF), chronic renal failure (CRF) and HIV infection were seen in 4.6%, 3.1% and2.3% of cases respectively. Notably, 13.1% of patients had no known co-morbidities. These findings highlight the significant burden of metabolic and chronic illnesses in sepsis patients and underscore the importance of early identification and tailored management strategies in high-risk populations (Table 1).

Table 2 summarizes the baseline vital signs and laboratory parameters of sepsis patients at the time of ICU admission. The average heart rate was 83.4 beats per minute, with a wide standard deviation (SD = 29.03), indicating variability in hemodynamic response. Respiratory rate averaged 18.76 breaths per minute, while the mean systolic and diastolic blood pressures were notably low at 84.9 mmHg and 49.77 mmHg respectively, reflecting the hypotensive state often seen in septic shock. The mean body temperature was 36.9°C, suggesting that not all patients exhibited fever at presentation. The median time to vasopressor initiation was 57.5 minutes, while the mean time to antibiotic administration was 2.14 hours, highlighting the urgency and variability in early sepsis management. Laboratory findings revealed elevated mean procalcitonin (4.78 ng/mL) and lactate levels (4.89 mmol/L), both markers of systemic inflammation and tissue hypoperfusion. These parameters collectively depict the critical physiological state of patients with sepsis and underscore the importance of timely clinical interventions.

Figure 1 illustrates that among sepsis patients, 60% required ICU admission, 45.4% underwent mechanical ventilation and 33.8% experienced mortality, reflecting the high severity and critical outcomes associated with the condition.

Table 3 presents a comparative analysis of the predictive performance of MEWS and LqSOFA scores for ICU admission, mechanical ventilationand mortality in sepsis patients. The MEWS score showed good accuracy for predicting ICU admission with an AUC of 0.768 (p = 0.0304), sensitivity of 80% and specificity of 75%. However, its predictive ability for mechanical ventilation (AUC = 0.604) and mortality (AUC = 0.574) was modest, with lower sensitivity and specificity values. In contrast, the LqSOFA score demonstrated excellent discrimination for mechanical ventilation (AUC = 0.800, p < 0.0001) and good performance in predicting mortality (AUC = 0.720, p < 0.0001), with higher sensitivity and specificity than MEWS. However, its predictive value for ICU admission was limited (AUC = 0.543, p = 0.3702). These findings suggest that while MEWS is more reliable for identifying patients needing ICU care, LqSOFA may be more effective in predicting the need for mechanical ventilation and mortality risk among sepsis patients.

Table 1: Distribution of Demographic Variables, Site of Infection and Co-Morbidities Among Sepsis Patients (n = 130)

Figure 1: Distribution of clinical outcomes among sepsis patients

Table 2: Baseline vital signs and laboratory parameters of sepsis patients at ICU admission

Table 3: Comparison of predictive accuracy of mews and LqSOFA scores for ICU admission, mechanical ventilation and mortality in sepsis patients

In this study, we evaluated the clinical outcomes and predictive value of MEWS and Lactate-enhanced qSOFA (LqSOFA) scores among sepsis patients admitted to a tertiary care hospital. The severity of illness was evident, with 60% requiring ICU admission, 45.4% undergoing mechanical ventilation and 33.8% experiencing mortality. These findings are consistent with previous studies such as Khwannimit et al., who reported a hospital mortality rate of 44.5% in septic shock patients in a tertiary hospital ICU in Thailand [9] and Usul et al., who observed a 52.3% 28-day mortality in elderly patients with sepsis [10]. Variations in mortality may be attributed to differences in study populations, comorbidities, clinical settings and the timing of interventions. Our findings emphasize the critical nature of sepsis and the need for early risk stratification to guide timely management decisions.

The comparative analysis of prognostic scores revealed that MEWS was superior in predicting ICU admission, with an AUC of 0.768, sensitivity of 80% and specificity of 75%. Conversely, LqSOFA demonstrated better performance in predicting mechanical ventilation AUC = 0.800, sensitivity 83.1% and mortality AUC = 0.720, sensitivity 77.3%. These findings suggest that while MEWS may be more useful in identifying patients who require immediate critical care, LqSOFA by incorporating lactate as a marker of hypoperfusion enhances the prediction of respiratory failure and death. Hence, the choice of prognostic tool should align with the specific clinical outcome being targeted. Our results corroborate findings from earlier research. Wattanasit et al. reported that MEWS and the Systemic Organ Score (SOS) were superior to LqSOFA  in detecting sepsis in emergency settings [11]. Similarly, Adegbite et al. and Odunku et al. identified significant variability in the pooled sensitivity and specificity of LqSOFA  across studies [12,13]. These disparities highlight the importance of contextual adaptation of scoring systems. While no single tool proves universally superior, using MEWS and LqSOFA in complementary roles could improve risk stratification. Larger, multicentric studies are needed to further validate these tools and explore hybrid models that combine the strengths of both.

In conclusion, this study highlights the substantial morbidity and mortality associated with sepsis, with a significant proportion of patients requiring ICU admission and mechanical ventilation. Among the prognostic tools evaluated, the MEWS score demonstrated superior predictive value for ICU admission, while the LqSOFA score was more accurate in predicting the need for mechanical ventilation and mortality. These findings suggest that both scoring systems have complementary roles in the early identification and risk stratification of sepsis patients. Implementing these tools in emergency and critical care settings may facilitate prompt clinical decision-making and improve patient outcomes. Future multicenter studies are recommended to validate these results and optimize sepsis management protocols in diverse clinical environments.

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