Abstract
BackgroundArterial lactate (AL) level is an important predictor of patient prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. However, if the AL range can be predicted from PVL, PVL may be an alternative method for predicting patient prognosis, and the risk of arterial puncture complications with AL may be reduced. This could be a safe and rapid test method.MethodsThis was a retrospective observational study of 125 cases in which blood gas analysis was performed on both arterial and venous blood with an infectious disease in an emergency department. Spearman’s rank correlation coefficient (r) and Bland–Altman analyses were performed. Sensitivity, specificity, and area under the curve (AUC) were calculated for PVL to predict AL < 2 mmol/L or < 4 mmol/L.ResultsThe median [interquartile range] AL and PVL were 1.82 [1.25–2.46] vs. 2.08 [1.57–3.28], respectively, r was 0.93 (p < 0.0001), and a strong correlation was observed; however, Bland–Altman analysis showed disagreement. When AL < 2 mmol/L was used as the outcome, AUC was 0.970, the PVL cutoff value was 2.55 mmol/L, sensitivity was 85.71%, and specificity was 96.05%. If PVL < 2 mmol/L was the outcome, the sensitivity for AL < 2mmol/L was 100%, and for PVL levels ≥ 3 mmol/L, the specificity was 100%. When AL < 4 mmol/L was used as the outcome, AUC was 0.967, the PVL cutoff value was 3.4 mmol/L, sensitivity was 100%, and specificity was 85.84%. When PVL < 3.5 mmol/L was the outcome, the sensitivity for AL < 4 mmol/L was 100%, and for PVL levels ≥ 4 mmol/L, the specificity was 93.81%.ConclusionsThis study revealed that PVL and AL levels in the same critically ill patients did not perfectly agree with each other but were strongly correlated. Furthermore, the high accuracy for predicting AL ranges from PVL levels explains why PVL levels could be used as a substitute for AL level ranges.
Highlights
Arterial lactate (AL) level is an important predictor of patient prognosis
In the Yokohama Municipal Citizen’s Hospital, we performed arterial blood gas analysis and peripheral venous blood gas analysis in 135 patients from August 2017 to February 2020; 125 patients were diagnosed with infection
In this study, we investigated the relationship between peripheral venous lactate (PVL) and AL levels in critically ill patients and determined whether PVL levels could substitute for ranges of AL levels
Summary
Arterial lactate (AL) level is an important predictor of patient prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. If the AL range can be predicted from PVL, PVL may be an alternative method for predicting patient prognosis, and the risk of arterial puncture complications with AL may be reduced This could be a safe and rapid test method. In patients with shock that could not be differentiated based on the cause, prognosis was poor when lactate levels were higher than 4 mmol/L [5] In those who survived, lactate levels decreased by 10% within 1 h following treatment initiation [6]. Blood gas analyses are performed repeatedly to measure arterial lactate (AL) levels in patients with severe conditions This testing requires arterial puncture and catheterization (arterial line placement) for blood collection, which is invasive and involves a risk of complications [9]
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