Relative Hyperlactatemia in the Emergency Department
Objective: The clinical interpretation of lactate ≤ 2.00 mmol/L in emergency department (ED) patients is not well-characterized. This study aims to determine the optimal cutoff value for lactate within the reference range that predicts in-hospital mortality among ED patients.Methods: This was a retr...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-09-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fmed.2020.00561/full |
| _version_ | 1818208217077907456 |
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| author | Ralphe Bou Chebl Sarah Jamali Nancy Mikati Reem Al Assaad Karim Abdel Daem Nadim Kattouf Rawan Safa Maha Makki Hani Tamim Gilbert Abou Dagher |
| author_facet | Ralphe Bou Chebl Sarah Jamali Nancy Mikati Reem Al Assaad Karim Abdel Daem Nadim Kattouf Rawan Safa Maha Makki Hani Tamim Gilbert Abou Dagher |
| author_sort | Ralphe Bou Chebl |
| collection | DOAJ |
| description | Objective: The clinical interpretation of lactate ≤ 2.00 mmol/L in emergency department (ED) patients is not well-characterized. This study aims to determine the optimal cutoff value for lactate within the reference range that predicts in-hospital mortality among ED patients.Methods: This was a retrospective study of adult patients presenting to a tertiary ED with an initial serum lactate level of <2.00 mmol/L. The primary outcome was in-hospital mortality. Youden's index was utilized to determine the optimal threshold that predicts mortality. Patients above the threshold were labeled as having relative hyperlactatemia.Results: During the study period, 1,638 patients were included. The mean age was 66.9 ± 18.6 years, 47.1% of the population were female, and the most prevalent comorbidity was hypertension (56.7%). The mean lactate level at presentation was 1.5 ± 0.3 mmol/L. In-hospital mortality was 3.8% in the overall population, and 16.2% were admitted to the ICU. A lactate level of 1.33 mmol/L was found to be the optimal cutoff that best discriminates between survivors and non-survivors. Relative hyperlactatemia was an independent predictor of in-hospital mortality (OR 1.78 C1.18–4.03; p = 0.02). Finally, relative hyperlactatemia was associated with increased mortality in patients without hypertension (4.7 vs. 1.1%; p = 0.008), as well as patients without diabetes or COPD.Conclusion: The optimal cutoff of initial serum lactate that discriminates between survivors and non-survivors in the ED is 1.33 mmol/L. Relative hyperlactatemia is associated with increased mortality in emergency department patients, and this interaction seems to be more important in healthy patients. |
| first_indexed | 2024-12-12T04:41:18Z |
| format | Article |
| id | doaj.art-f8b817397b8b457fbe72c225e15c586f |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-12T04:41:18Z |
| publishDate | 2020-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-f8b817397b8b457fbe72c225e15c586f2022-12-22T00:37:48ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-09-01710.3389/fmed.2020.00561574453Relative Hyperlactatemia in the Emergency DepartmentRalphe Bou Chebl0Sarah Jamali1Nancy Mikati2Reem Al Assaad3Karim Abdel Daem4Nadim Kattouf5Rawan Safa6Maha Makki7Hani Tamim8Gilbert Abou Dagher9Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, LebanonDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, LebanonDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, LebanonDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, LebanonDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, LebanonDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, LebanonDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, LebanonDepartment of Internal Medicine, Clinical Research Institute, American University of Beirut, Beirut, LebanonDepartment of Internal Medicine, Clinical Research Institute, American University of Beirut, Beirut, LebanonDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, LebanonObjective: The clinical interpretation of lactate ≤ 2.00 mmol/L in emergency department (ED) patients is not well-characterized. This study aims to determine the optimal cutoff value for lactate within the reference range that predicts in-hospital mortality among ED patients.Methods: This was a retrospective study of adult patients presenting to a tertiary ED with an initial serum lactate level of <2.00 mmol/L. The primary outcome was in-hospital mortality. Youden's index was utilized to determine the optimal threshold that predicts mortality. Patients above the threshold were labeled as having relative hyperlactatemia.Results: During the study period, 1,638 patients were included. The mean age was 66.9 ± 18.6 years, 47.1% of the population were female, and the most prevalent comorbidity was hypertension (56.7%). The mean lactate level at presentation was 1.5 ± 0.3 mmol/L. In-hospital mortality was 3.8% in the overall population, and 16.2% were admitted to the ICU. A lactate level of 1.33 mmol/L was found to be the optimal cutoff that best discriminates between survivors and non-survivors. Relative hyperlactatemia was an independent predictor of in-hospital mortality (OR 1.78 C1.18–4.03; p = 0.02). Finally, relative hyperlactatemia was associated with increased mortality in patients without hypertension (4.7 vs. 1.1%; p = 0.008), as well as patients without diabetes or COPD.Conclusion: The optimal cutoff of initial serum lactate that discriminates between survivors and non-survivors in the ED is 1.33 mmol/L. Relative hyperlactatemia is associated with increased mortality in emergency department patients, and this interaction seems to be more important in healthy patients.https://www.frontiersin.org/article/10.3389/fmed.2020.00561/fulllactatemortalityemergency & critical caremorbiditysepsis |
| spellingShingle | Ralphe Bou Chebl Sarah Jamali Nancy Mikati Reem Al Assaad Karim Abdel Daem Nadim Kattouf Rawan Safa Maha Makki Hani Tamim Gilbert Abou Dagher Relative Hyperlactatemia in the Emergency Department Frontiers in Medicine lactate mortality emergency & critical care morbidity sepsis |
| title | Relative Hyperlactatemia in the Emergency Department |
| title_full | Relative Hyperlactatemia in the Emergency Department |
| title_fullStr | Relative Hyperlactatemia in the Emergency Department |
| title_full_unstemmed | Relative Hyperlactatemia in the Emergency Department |
| title_short | Relative Hyperlactatemia in the Emergency Department |
| title_sort | relative hyperlactatemia in the emergency department |
| topic | lactate mortality emergency & critical care morbidity sepsis |
| url | https://www.frontiersin.org/article/10.3389/fmed.2020.00561/full |
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