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The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study
INTRODUCTION: A limitation of pre-hospital monitoring is that vital signs often do not change until a patient is in a critical stage. Blood lactate levels are suggested as a more sensitive parameter to evaluate a patient's condition. The aim of this pilot study was to find presumptive evidence...
Autores principales: | , , , , , |
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Formato: | Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2008
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646325/ https://www.ncbi.nlm.nih.gov/pubmed/19091118 http://dx.doi.org/10.1186/cc7159 |
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author | Jansen, Tim C van Bommel, Jasper Mulder, Paul G Rommes, Johannes H Schieveld, Selma JM Bakker, Jan |
author_facet | Jansen, Tim C van Bommel, Jasper Mulder, Paul G Rommes, Johannes H Schieveld, Selma JM Bakker, Jan |
author_sort | Jansen, Tim C |
collection | PubMed |
description | INTRODUCTION: A limitation of pre-hospital monitoring is that vital signs often do not change until a patient is in a critical stage. Blood lactate levels are suggested as a more sensitive parameter to evaluate a patient's condition. The aim of this pilot study was to find presumptive evidence for a relation between pre-hospital lactate levels and in-hospital mortality, corrected for vital sign abnormalities. METHODS: In this prospective observational study (n = 124), patients who required urgent ambulance dispatching and had a systolic blood pressure below 100 mmHg, a respiratory rate less than 10 or more than 29 breaths/minute, or a Glasgow Coma Scale (GCS) below 14 were enrolled. Nurses from Emergency Medical Services measured capillary or venous lactate levels using a hand-held device on arrival at the scene (T1) and just before or on arrival at the emergency department (T2). The primary outcome measured was in-hospital mortality. RESULTS: The average (standard deviation) time from T1 to T2 was 27 (10) minutes. Non-survivors (n = 32, 26%) had significantly higher lactate levels than survivors at T1 (5.3 vs 3.7 mmol/L) and at T2 (5.4 vs 3.2 mmol/L). Mortality was significantly higher in patients with lactate levels of 3.5 mmol/L or higher compared with those with lactate levels below 3.5 mmol/L (T1: 41 vs 12% and T2: 47 vs 15%). Also in the absence of hypotension, mortality was higher in those with higher lactate levels. In a multivariable Cox proportional hazard analysis including systolic blood pressure, heart rate, GCS (all at T1) and delta lactate level (from T1 to T2), only delta lactate level (hazard ratio (HR) = 0.20, 95% confidence interval (CI) = 0.05 to 0.76, p = 0.018) and GCS (HR = 0.93, 95% CI = 0.88 to 0.99, p = 0.022) were significant independent predictors of in-hospital mortality. CONCLUSIONS: In a cohort of patients that required urgent ambulance dispatching, pre-hospital blood lactate levels were associated with in-hospital mortality and provided prognostic information superior to that provided by the patient's vital signs. There is potential for early detection of occult shock and pre-hospital resuscitation guided by lactate measurement. However, external validation is required before widespread implementation of lactate measurement in the out-of-hospital setting. |
format | Text |
id | pubmed-2646325 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2008 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-26463252009-02-24 The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study Jansen, Tim C van Bommel, Jasper Mulder, Paul G Rommes, Johannes H Schieveld, Selma JM Bakker, Jan Crit Care Research INTRODUCTION: A limitation of pre-hospital monitoring is that vital signs often do not change until a patient is in a critical stage. Blood lactate levels are suggested as a more sensitive parameter to evaluate a patient's condition. The aim of this pilot study was to find presumptive evidence for a relation between pre-hospital lactate levels and in-hospital mortality, corrected for vital sign abnormalities. METHODS: In this prospective observational study (n = 124), patients who required urgent ambulance dispatching and had a systolic blood pressure below 100 mmHg, a respiratory rate less than 10 or more than 29 breaths/minute, or a Glasgow Coma Scale (GCS) below 14 were enrolled. Nurses from Emergency Medical Services measured capillary or venous lactate levels using a hand-held device on arrival at the scene (T1) and just before or on arrival at the emergency department (T2). The primary outcome measured was in-hospital mortality. RESULTS: The average (standard deviation) time from T1 to T2 was 27 (10) minutes. Non-survivors (n = 32, 26%) had significantly higher lactate levels than survivors at T1 (5.3 vs 3.7 mmol/L) and at T2 (5.4 vs 3.2 mmol/L). Mortality was significantly higher in patients with lactate levels of 3.5 mmol/L or higher compared with those with lactate levels below 3.5 mmol/L (T1: 41 vs 12% and T2: 47 vs 15%). Also in the absence of hypotension, mortality was higher in those with higher lactate levels. In a multivariable Cox proportional hazard analysis including systolic blood pressure, heart rate, GCS (all at T1) and delta lactate level (from T1 to T2), only delta lactate level (hazard ratio (HR) = 0.20, 95% confidence interval (CI) = 0.05 to 0.76, p = 0.018) and GCS (HR = 0.93, 95% CI = 0.88 to 0.99, p = 0.022) were significant independent predictors of in-hospital mortality. CONCLUSIONS: In a cohort of patients that required urgent ambulance dispatching, pre-hospital blood lactate levels were associated with in-hospital mortality and provided prognostic information superior to that provided by the patient's vital signs. There is potential for early detection of occult shock and pre-hospital resuscitation guided by lactate measurement. However, external validation is required before widespread implementation of lactate measurement in the out-of-hospital setting. BioMed Central 2008 2008-12-17 /pmc/articles/PMC2646325/ /pubmed/19091118 http://dx.doi.org/10.1186/cc7159 Text en Copyright © 2008 Jansen et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Jansen, Tim C van Bommel, Jasper Mulder, Paul G Rommes, Johannes H Schieveld, Selma JM Bakker, Jan The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study |
title | The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study |
title_full | The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study |
title_fullStr | The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study |
title_full_unstemmed | The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study |
title_short | The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study |
title_sort | prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646325/ https://www.ncbi.nlm.nih.gov/pubmed/19091118 http://dx.doi.org/10.1186/cc7159 |
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