Assessing lactate concentration as a predictor of 28‐day in‐hospital mortality in the presence of ethanol: A retrospective study of emergency department patients

Abstract Background Presence of ethanol (EtOH) may alter the relationship between blood lactate concentrations and mortality. This study compares lactate‐associated mortality risk in the presence and absence of EtOH. Methods We performed a retrospective cohort study including all patients, age >1...

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Main Authors: Arvin Radfar Akhavan, Nicholas J. Johnson, Benjamin Friedman, Jane Hall, Karl Jablonowski, M. Kennedy Hall, Daniel J. Henning
Format: Article
Language:English
Published: Wiley 2021-04-01
Series:Journal of the American College of Emergency Physicians Open
Subjects:
Online Access:https://doi.org/10.1002/emp2.12397
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author Arvin Radfar Akhavan
Nicholas J. Johnson
Benjamin Friedman
Jane Hall
Karl Jablonowski
M. Kennedy Hall
Daniel J. Henning
author_facet Arvin Radfar Akhavan
Nicholas J. Johnson
Benjamin Friedman
Jane Hall
Karl Jablonowski
M. Kennedy Hall
Daniel J. Henning
author_sort Arvin Radfar Akhavan
collection DOAJ
description Abstract Background Presence of ethanol (EtOH) may alter the relationship between blood lactate concentrations and mortality. This study compares lactate‐associated mortality risk in the presence and absence of EtOH. Methods We performed a retrospective cohort study including all patients, age >17 years, presenting from January 2012–December 2018, to an urban, academic emergency department, with a clinically measured lactate. Data were electronically abstracted from the medical record. The primary outcome was 28‐day in‐hospital mortality. Patients were grouped by EtOH test results as follows: 1) present (any EtOH detected), 2) absent (EtOH concentration measured and not detected), or 3) not ordered. Marginal analysis was used to calculated probability of mortality for fixed values of lactate and model covariates. Results Of 40,956 adult emergency department patients with measured lactate, we excluded 768 (1.89%) for lactate >10.0 mmol/L, leaving 40,240 for analysis: 4,066 (10.1%) EtOH present, 10,819 (26.9%) EtOH absent, 25,355 (63%) EtOH not ordered. Of these, 1790 (4.4%) had 28‐day in‐hospital mortality. Marginal probability of mortality calculated for specific lactate values found less risk for EtOH Present patients versus EtOH absent patients at lactate 0.0 mmol/L (0.8% [95%CI: 0.5–1.2%] vs 3.2% [2.8–3.6%]), 2.0 mmol/L (1.5% [1.1–1.9%] vs 4.0% [3.7–4.3%]), 4.0 mmol/L (2.6% [2.2–3.1%] vs 5.0% [4.6–5.4%]), until 6.0 mmol/L (4.5% [3.7–5.4%] vs 6.2% [5.4–7.0%]). Conclusion EtOH presence significantly alters lactate‐associated mortality risk when lactate <6.0 mmol/L. Emergency department clinicians should interpret these lactate values with caution and consider other data for risk stratification when EtOH is present.
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spelling doaj.art-5289959885cc478380515a73f3d84eda2022-12-21T17:15:46ZengWileyJournal of the American College of Emergency Physicians Open2688-11522021-04-0122n/an/a10.1002/emp2.12397Assessing lactate concentration as a predictor of 28‐day in‐hospital mortality in the presence of ethanol: A retrospective study of emergency department patientsArvin Radfar Akhavan0Nicholas J. Johnson1Benjamin Friedman2Jane Hall3Karl Jablonowski4M. Kennedy Hall5Daniel J. Henning6Department of Emergency Medicine University of Washington Seattle Washington USADepartment of Emergency Medicine University of Washington Seattle Washington USADepartment of Emergency Medicine University of Washington Seattle Washington USADepartment of Emergency Medicine University of Washington Seattle Washington USADepartment of Emergency Medicine University of Washington Seattle Washington USADepartment of Emergency Medicine University of Washington Seattle Washington USADepartment of Emergency Medicine University of Washington Seattle Washington USAAbstract Background Presence of ethanol (EtOH) may alter the relationship between blood lactate concentrations and mortality. This study compares lactate‐associated mortality risk in the presence and absence of EtOH. Methods We performed a retrospective cohort study including all patients, age >17 years, presenting from January 2012–December 2018, to an urban, academic emergency department, with a clinically measured lactate. Data were electronically abstracted from the medical record. The primary outcome was 28‐day in‐hospital mortality. Patients were grouped by EtOH test results as follows: 1) present (any EtOH detected), 2) absent (EtOH concentration measured and not detected), or 3) not ordered. Marginal analysis was used to calculated probability of mortality for fixed values of lactate and model covariates. Results Of 40,956 adult emergency department patients with measured lactate, we excluded 768 (1.89%) for lactate >10.0 mmol/L, leaving 40,240 for analysis: 4,066 (10.1%) EtOH present, 10,819 (26.9%) EtOH absent, 25,355 (63%) EtOH not ordered. Of these, 1790 (4.4%) had 28‐day in‐hospital mortality. Marginal probability of mortality calculated for specific lactate values found less risk for EtOH Present patients versus EtOH absent patients at lactate 0.0 mmol/L (0.8% [95%CI: 0.5–1.2%] vs 3.2% [2.8–3.6%]), 2.0 mmol/L (1.5% [1.1–1.9%] vs 4.0% [3.7–4.3%]), 4.0 mmol/L (2.6% [2.2–3.1%] vs 5.0% [4.6–5.4%]), until 6.0 mmol/L (4.5% [3.7–5.4%] vs 6.2% [5.4–7.0%]). Conclusion EtOH presence significantly alters lactate‐associated mortality risk when lactate <6.0 mmol/L. Emergency department clinicians should interpret these lactate values with caution and consider other data for risk stratification when EtOH is present.https://doi.org/10.1002/emp2.12397alcoholemergency departmentethanollactatemortality
spellingShingle Arvin Radfar Akhavan
Nicholas J. Johnson
Benjamin Friedman
Jane Hall
Karl Jablonowski
M. Kennedy Hall
Daniel J. Henning
Assessing lactate concentration as a predictor of 28‐day in‐hospital mortality in the presence of ethanol: A retrospective study of emergency department patients
Journal of the American College of Emergency Physicians Open
alcohol
emergency department
ethanol
lactate
mortality
title Assessing lactate concentration as a predictor of 28‐day in‐hospital mortality in the presence of ethanol: A retrospective study of emergency department patients
title_full Assessing lactate concentration as a predictor of 28‐day in‐hospital mortality in the presence of ethanol: A retrospective study of emergency department patients
title_fullStr Assessing lactate concentration as a predictor of 28‐day in‐hospital mortality in the presence of ethanol: A retrospective study of emergency department patients
title_full_unstemmed Assessing lactate concentration as a predictor of 28‐day in‐hospital mortality in the presence of ethanol: A retrospective study of emergency department patients
title_short Assessing lactate concentration as a predictor of 28‐day in‐hospital mortality in the presence of ethanol: A retrospective study of emergency department patients
title_sort assessing lactate concentration as a predictor of 28 day in hospital mortality in the presence of ethanol a retrospective study of emergency department patients
topic alcohol
emergency department
ethanol
lactate
mortality
url https://doi.org/10.1002/emp2.12397
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