Abstract
One of the challenges in the emergency department (ED) is the early identification of patients with a higher risk of clinical deterioration. The objective is to evaluate the prognostic capacity of ΔLA (correlation between prehospital lactate (pLA) and hospital lactate (hLA)) with respect to in-hospital two day mortality. We conducted a pragmatic, multicentric, prospective and blinded-endpoint study in adults who consecutively attended and were transported in advanced life support with high priority from the scene to the ED. The corresponding area under the receiver operating characteristics curve (AUROC) was obtained for each of the outcomes. In total, 1341 cases met the inclusion criteria. The median age was 71 years (interquartile range: 54–83 years), with 38.9% (521 cases) females. The total 2 day mortality included 106 patients (7.9%). The prognostic precision for the 2 day mortality of pLA and hLA was good, with an AUROC of 0.800 (95% CI: 0.74–0.85; p < 0.001) and 0.819 (95% CI: 0.76–0.86; p < 0.001), respectively. Of all patients, 31.5% (422 cases) had an ΔLA with a decrease of <10%, of which a total of 66 patients (15.6%) died. A lactate clearance ≥ 10% is associated with a lower risk of death in the ED, and this value could potentially be used as a guide to determine if a severely injured patient is improving in response to the established treatment.
Highlights
Hyperlactacidemia is often caused by an imbalance between oxygen supply and demand, and elevated lactate can be seen as a non-specific marker of tissue hypoxemia, with this being a documented risk factor for mortality in patients with a serious and, an infectious pathology [7,8]
Requests for assistance are evaluated by a physician at the emergency coordination centre who determines the most appropriate resource based on care needs
1341 cases metcases the inclusion criteria
Summary
There are a series of early warning scores based on different physiological parameters, which are capable of predicting the risk of deterioration in EDs [2,3], there are still situations in which. Hyperlactacidemia is often caused by an imbalance between oxygen supply and demand, and elevated lactate can be seen as a non-specific marker of tissue hypoxemia, with this being a documented risk factor for mortality in patients with a serious and, an infectious pathology [7,8]. The predictive value of a single lactate measurement as an indicator of hypoxic cellular distress is being investigated [9], and even more so, to detect mortality beyond the first 24 h [10]. A second lactate measurement can help to quantify the change from the initial measurement, which is called delta lactate (∆LA), with a direct relationship with mortality [11,12]
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