Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Kimie Oedorf, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
  • ,
  • DE Day, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts11Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • ,
  • Y Lior, Ben-Gurion University of the Negev, Clinical Research Center Soroka University Medical Center, and Faculty of Health Sciences, Beersheba, Israel.
  • ,
  • V Novack, Ben-Gurion University of the Negev, Clinical Research Center Soroka University Medical Center, and Faculty of Health Sciences, Beersheba, Israel.
  • ,
  • LD Sanchez, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts11Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • ,
  • RE Wolfe, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts11Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • ,
  • Hans Kirkegaard
  • Nathan I Shapiro, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts11Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • ,
  • DJ Henning, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts11Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

INTRODUCTION: Lactate 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.

METHODS: We 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.

RESULTS: Of 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).

CONCLUSION: Lactate levels can risk stratify patients with AVS who have increased risk of adverse outcomes regardless of infection status.

OriginalsprogEngelsk
TidsskriftThe western journal of emergency medicine
Vol/bind18
Nummer2
Sider (fra-til)258-266
Antal sider9
ISSN1936-900X
DOI
StatusUdgivet - feb. 2017

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