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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 patien...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Department of Emergency Medicine, University of California, Irvine School of Medicine
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5305135/ https://www.ncbi.nlm.nih.gov/pubmed/28210362 http://dx.doi.org/10.5811/westjem.2016.10.31397 |
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author | Oedorf, Kimie Day, Danielle E. Lior, Yotam Novack, Victor Sanchez, Leon D. Wolfe, Richard E. Kirkegaard, Hans Shapiro, Nathan I. Henning, Daniel J. |
author_facet | Oedorf, Kimie Day, Danielle E. Lior, Yotam Novack, Victor Sanchez, Leon D. Wolfe, Richard E. Kirkegaard, Hans Shapiro, Nathan I. Henning, Daniel J. |
author_sort | Oedorf, Kimie |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5305135 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Department of Emergency Medicine, University of California, Irvine School of Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-53051352017-02-16 Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection Oedorf, Kimie Day, Danielle E. Lior, Yotam Novack, Victor Sanchez, Leon D. Wolfe, Richard E. Kirkegaard, Hans Shapiro, Nathan I. Henning, Daniel J. West J Emerg Med Health Outcomes 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. Department of Emergency Medicine, University of California, Irvine School of Medicine 2017-02 2016-12-07 /pmc/articles/PMC5305135/ /pubmed/28210362 http://dx.doi.org/10.5811/westjem.2016.10.31397 Text en Copyright: © 2017 Oedorf et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Health Outcomes Oedorf, Kimie Day, Danielle E. Lior, Yotam Novack, Victor Sanchez, Leon D. Wolfe, Richard E. Kirkegaard, Hans Shapiro, Nathan I. Henning, Daniel J. Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection |
title | Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection |
title_full | Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection |
title_fullStr | Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection |
title_full_unstemmed | Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection |
title_short | Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection |
title_sort | serum lactate predicts adverse outcomes in emergency department patients with and without infection |
topic | Health Outcomes |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5305135/ https://www.ncbi.nlm.nih.gov/pubmed/28210362 http://dx.doi.org/10.5811/westjem.2016.10.31397 |
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