Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection
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 pati...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2017-02-01
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| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/4391g55t.pdf |
| Summary: | 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. [West J Emerg Med. 2017;18(2)258-266.] |
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| ISSN: | 1936-900X 1936-9018 |