Abstract 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). 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.
Unal et al. (2026) studied this question.