Abstract
IntroductionLactate levels are increasingly used to risk stratify emergency department (ED) patients with and without infection. Whether a serum lactate provides similar prognostic value across diseases is not fully elucidated. This study assesses the prognostic value of serum lactate in ED patients with and without infection to both report and compare relative predictive value across etiologies.MethodsWe conducted a prospective, observational study of ED patients displaying abnormal vital signs (AVS) (heart rate ≥130 bpm, respiratory rate ≥24 bpm, shock index ≥1, and/or systolic blood pressure <90 mmHg). The primary outcome, deterioration, was a composite of acute renal failure, non-elective intubation, vasopressor administration or in-hospital mortality.ResultsOf the 1,152 patients with AVS who were screened, 488 patients met the current study criteria: 34% deteriorated and 12.5% died. The deterioration rate was 88/342 (26%, 95% CI: 21 – 30%) for lactate < 2.5 mmol/L, 47/90 (52%, 42 – 63%) for lactate 2.5 – 4.0 mmol/L, and 33/46 (72%, 59 – 85%) for lactate >4.0mmol/L. Trended stratified lactate levels were associated with deterioration for both infected (p<0.01) and non-infected (p<0.01) patients. In the logistic regression models, lactate > 4mmol/L was an independent predictor of deterioration for patients with infection (OR 4.8, 95% CI: 1.7 – 14.1) and without infection (OR 4.4, 1.7 – 11.5).ConclusionLactate levels can risk stratify patients with AVS who have increased risk of adverse outcomes regardless of infection status.
Highlights
Lactate levels are increasingly used to risk stratify emergency department (ED) patients with and without infection
Trended stratified lactate levels were associated with deterioration for both infected (p
In the logistic regression models, lactate > 4mmol/L was an independent predictor of deterioration for patients with infection and without infection
Summary
Lactate levels are increasingly used to risk stratify emergency department (ED) patients with and without infection. The use of lactate to identify patients at risk for adverse outcomes and to guide treatment decisions for emergency department (ED) patients with infection has gained widespread adoption based upon a number of studies.[1,2,3,4,5,6] The Surviving Sepsis Campaign[7] has incorporated the measurement of serum lactate concentrations into its most current guidelines, emphasizing measurement within three hours of identification of sepsis. 15 a recent study from Denmark demonstrated that stratified lactate concentrations predict 10-day mortality in an undifferentiated acute care population that had a lactate measured.[16] this study did not assess the potential effect of the underlying disease, it further supports the use of lactate to risk stratify patients regardless of diagnosis
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