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Abstract
BackgroundDespite of numerous evidences that elevated serum lactate levels were associated with unfavorable outcomes, there have been no study demonstrated an optimal cutoff of serum lactate in unselected patients. This study was aimed to evaluate the prognostic property of lactate, and to identify a cutoff of serum lactate level for predicting 30-day in-hospital mortality among unselected patients presenting to the emergency department (ED).MethodsWe performed a retrospective observational study from January 2010 to December 2016. 61,151 patients were used for propensity score analysis after exclusion. 14,015 patients who underwent lactate test at ED arrival were enrolled for final analysis.ResultsThe average treatment effect (ATE) of carrying out a lactate test on 30-day in-hospital mortality was 0.53% (adjusted odds ratio (OR) = 1.013, p = 0.19; 95% confidence interval (CI), 0.997–1.013). Adjusted OR of serum lactate calculated from multivariable analysis was 1.09 (p < 0.001; 95% CI, 1.07–1.10). The area under a ROC curve (AUC) of serum lactate was 0.711 (p < 0.001; 95% CI, 0.703–0.718). The sensitivity, specificity, and positive and negative predictive values for the cutoff > 2.6 mmol/L were 56.7%, 74.3%, 20.8%, and 93.5%, respectively. Mortality of the high-lactate group (> 2.6 mmol/L) was significantly higher than that of the low lactate group (≤ 2.6 mmol/L) (20.8% vs. 6.5%, difference = 14.3%, p < 0.01; 95% CI, 13.0% - 15.7%).ConclusionsA serum lactate level > 2.6 mmol/L predicted 30-day in-hospital mortality in unselected patients who arrived to the ED and were admitted to the hospital. Additionally, serum lactate test in the ED could be an effective screening method for identifying low risk patients.
Highlights
Hyperlactatemia has been shown to be related to higher mortality in selected patients admitted in the intensive care units (ICUs) with specific conditions such as sepsis, trauma, or critical illness [1, 2]
Adjusted odds ratio (OR) of serum lactate calculated from multivariable analysis was 1.09 (p < 0.001; 95% confidence interval (CI), 1.07–1.10)
A serum lactate level > 2.6 mmol/L predicted 30-day in-hospital mortality in unselected patients who arrived to the emergency department (ED) and were admitted to the hospital
Summary
Hyperlactatemia has been shown to be related to higher mortality in selected patients admitted in the intensive care units (ICUs) with specific conditions such as sepsis, trauma, or critical illness [1, 2]. Many previous studies evaluated the relationship between serum lactate level and mortality in ED patients with specific diagnoses [5, 6], studies of unselected patients were few [7, 8]. Because serum lactate tests have not been established as part of a routine work up in unselected ED patients, selection bias was unavoidable in studies that evaluated the relationship between serum lactate level and mortality in patients in the ED setting. To overcome this limitation, a recent study included a control group of patients in whom lactate was not measured; the study showed hyperlactatemia was associated with higher mortality.
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