One of the key strategies for improving sepsis management is identifying the subgroup of patients with infection who are at high risk of developing adverse outcomes. This may help clinicians to initiate early treatment, such as early antibiotic administration and fluid resuscitation. Sometimes SIRS criteria are not fulfilled in sepsis and do not meaningfully contribute to the identification of patients with suspected infection who are at higher risk of an unfortunate course, ICU admission, or death.As stated above, recent definitions have specified that septic shock is a subset of sepsis in which circulatory and metabolic abnormalities are profound enough to increase mortality risk substantially.Criteria proposed for septic shock include (1) sepsis plus (2) the need for vasopressor therapy to elevate mean arterial pressure to ≥65 mmHg, with (3) a serum lactate concentration >2.0 mmol/L after adequate fluid resuscitation.The primary physiologic organ dysfunction's manifestations can be assessed quickly with a six-organ framework, yielding the SOFA score. Particular focus should then be placed on the presence or absence of shock, which constitutes a clinical emergency. The general manifestations of shock include arterial hypotension with evidence of tissue hypoperfusion (e.g. oliguria, altered mental status, poor peripheral perfusion, or hyperlactatemia).The SOFA (Figure 2) [10] uses different physiological variables to assess each organ's dysfunctions: PaO2/FiO2 for respiratory function's evaluation; platelets for coagulation, bilirubin for liver function, mean arterial pressure and use of vasopressors for the cardiovascular system, Glasgow Coma Scale for the central nervous system, creatinine and diuresis for renal function.The SOFA score is widely studied in the ICU among patients with infection, sepsis, and shock. With ≥2 new SOFA points, the infected patient is considered septic and may be at ≥10% risk of in-hospital death. As previously said, the Society of Critical Care Medicine (SCCM) and the European Society of Critical Care Medicine (ESICM) recommended using the quick SOFA (qSOFA)to screen for sepsis in non-intensive care unit settings (ICU) [10] . qSOFA is simple and easy to use for alerting clinicians to consider possible sepsis. However, studies showed that qSOFA has limited accuracy for predicting adverse outcomes in sepsis patients [23,24,25] .The early warning scores (EWS) were developed for bedside evaluation, as track and trigger systems, to detect patient deterioration early. The most popular EWS were the Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS).EWS are simple, bedside tools based on physiologic parameter changes and do not require laboratory results as does the SOFA score. However, these scores are commonly implemented for risk assessment and stratification tools in clinical practice in wards or emergency department. MEWS (Figure 3) [26] has been validated in several critically ill patients and showed that this score could predict hospital admission and mortality outcome. Several studies [27,28] evaluated the accuracy of NEWS (Figure 4) [29] in sepsis patients in the emergency department and wards and revealed that it could be used to predict death and ICU admission.EWS are track and triggers of physiological parameters that allow early detection of patient deterioration at many healthcare levels (pre-hospital, emergency department, and wards). MEWS and NEWS both include: temperature, respiratory rate, heart rate, blood pressure, and level of consciousness. The difference between the score is that MEWS includes a scoring for urine output, whereas the NEWS uses oxygen saturation and oxygen supplement. There is still inconsistent data for the accuracy of EWS for predicting mortality or adverse outcomes in sepsis patients.However, the SOFA score provides the best discrimination to predict hospital mortality compared to other scores in ICU sepsis patients [23,30] . 