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Peripheral venous lactate levels substitute arterial lactate levels in the emergency department
BACKGROUND: Arterial lactate (AL) level is an important predictor of patient prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. However, if the AL range can be predicted from PVL, PVL may be an alternati...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8903598/ https://www.ncbi.nlm.nih.gov/pubmed/35090392 http://dx.doi.org/10.1186/s12245-022-00410-y |
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author | Oi, Yasufumi Mori, Kosuke Yamagata, Hidehiro Nogaki, Ayako Takeda, Tomoaki Watanabe, Chikara Sakaguchi, Yusuke Ogawa, Fumihiro Abe, Takeru Imaki, Shouhei Takeuchi, Ichiro |
author_facet | Oi, Yasufumi Mori, Kosuke Yamagata, Hidehiro Nogaki, Ayako Takeda, Tomoaki Watanabe, Chikara Sakaguchi, Yusuke Ogawa, Fumihiro Abe, Takeru Imaki, Shouhei Takeuchi, Ichiro |
author_sort | Oi, Yasufumi |
collection | PubMed |
description | BACKGROUND: Arterial lactate (AL) level is an important predictor of patient prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. However, if the AL range can be predicted from PVL, PVL may be an alternative method for predicting patient prognosis, and the risk of arterial puncture complications with AL may be reduced. This could be a safe and rapid test method. METHODS: This was a retrospective observational study of 125 cases in which blood gas analysis was performed on both arterial and venous blood with an infectious disease in an emergency department. Spearman’s rank correlation coefficient (r) and Bland–Altman analyses were performed. Sensitivity, specificity, and area under the curve (AUC) were calculated for PVL to predict AL < 2 mmol/L or < 4 mmol/L. RESULTS: The median [interquartile range] AL and PVL were 1.82 [1.25–2.46] vs. 2.08 [1.57–3.28], respectively, r was 0.93 (p < 0.0001), and a strong correlation was observed; however, Bland–Altman analysis showed disagreement. When AL < 2 mmol/L was used as the outcome, AUC was 0.970, the PVL cutoff value was 2.55 mmol/L, sensitivity was 85.71%, and specificity was 96.05%. If PVL < 2 mmol/L was the outcome, the sensitivity for AL < 2mmol/L was 100%, and for PVL levels ≥ 3 mmol/L, the specificity was 100%. When AL < 4 mmol/L was used as the outcome, AUC was 0.967, the PVL cutoff value was 3.4 mmol/L, sensitivity was 100%, and specificity was 85.84%. When PVL < 3.5 mmol/L was the outcome, the sensitivity for AL < 4 mmol/L was 100%, and for PVL levels ≥ 4 mmol/L, the specificity was 93.81%. CONCLUSIONS: This study revealed that PVL and AL levels in the same critically ill patients did not perfectly agree with each other but were strongly correlated. Furthermore, the high accuracy for predicting AL ranges from PVL levels explains why PVL levels could be used as a substitute for AL level ranges. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12245-022-00410-y. |
format | Online Article Text |
id | pubmed-8903598 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-89035982022-03-23 Peripheral venous lactate levels substitute arterial lactate levels in the emergency department Oi, Yasufumi Mori, Kosuke Yamagata, Hidehiro Nogaki, Ayako Takeda, Tomoaki Watanabe, Chikara Sakaguchi, Yusuke Ogawa, Fumihiro Abe, Takeru Imaki, Shouhei Takeuchi, Ichiro Int J Emerg Med Original Research BACKGROUND: Arterial lactate (AL) level is an important predictor of patient prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. However, if the AL range can be predicted from PVL, PVL may be an alternative method for predicting patient prognosis, and the risk of arterial puncture complications with AL may be reduced. This could be a safe and rapid test method. METHODS: This was a retrospective observational study of 125 cases in which blood gas analysis was performed on both arterial and venous blood with an infectious disease in an emergency department. Spearman’s rank correlation coefficient (r) and Bland–Altman analyses were performed. Sensitivity, specificity, and area under the curve (AUC) were calculated for PVL to predict AL < 2 mmol/L or < 4 mmol/L. RESULTS: The median [interquartile range] AL and PVL were 1.82 [1.25–2.46] vs. 2.08 [1.57–3.28], respectively, r was 0.93 (p < 0.0001), and a strong correlation was observed; however, Bland–Altman analysis showed disagreement. When AL < 2 mmol/L was used as the outcome, AUC was 0.970, the PVL cutoff value was 2.55 mmol/L, sensitivity was 85.71%, and specificity was 96.05%. If PVL < 2 mmol/L was the outcome, the sensitivity for AL < 2mmol/L was 100%, and for PVL levels ≥ 3 mmol/L, the specificity was 100%. When AL < 4 mmol/L was used as the outcome, AUC was 0.967, the PVL cutoff value was 3.4 mmol/L, sensitivity was 100%, and specificity was 85.84%. When PVL < 3.5 mmol/L was the outcome, the sensitivity for AL < 4 mmol/L was 100%, and for PVL levels ≥ 4 mmol/L, the specificity was 93.81%. CONCLUSIONS: This study revealed that PVL and AL levels in the same critically ill patients did not perfectly agree with each other but were strongly correlated. Furthermore, the high accuracy for predicting AL ranges from PVL levels explains why PVL levels could be used as a substitute for AL level ranges. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12245-022-00410-y. Springer Berlin Heidelberg 2022-01-28 /pmc/articles/PMC8903598/ /pubmed/35090392 http://dx.doi.org/10.1186/s12245-022-00410-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Original Research Oi, Yasufumi Mori, Kosuke Yamagata, Hidehiro Nogaki, Ayako Takeda, Tomoaki Watanabe, Chikara Sakaguchi, Yusuke Ogawa, Fumihiro Abe, Takeru Imaki, Shouhei Takeuchi, Ichiro Peripheral venous lactate levels substitute arterial lactate levels in the emergency department |
title | Peripheral venous lactate levels substitute arterial lactate levels in the emergency department |
title_full | Peripheral venous lactate levels substitute arterial lactate levels in the emergency department |
title_fullStr | Peripheral venous lactate levels substitute arterial lactate levels in the emergency department |
title_full_unstemmed | Peripheral venous lactate levels substitute arterial lactate levels in the emergency department |
title_short | Peripheral venous lactate levels substitute arterial lactate levels in the emergency department |
title_sort | peripheral venous lactate levels substitute arterial lactate levels in the emergency department |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8903598/ https://www.ncbi.nlm.nih.gov/pubmed/35090392 http://dx.doi.org/10.1186/s12245-022-00410-y |
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