Peripheral venous lactate at admission is associated with in-hospital mortality: a prospective cohort study

TY - JOUR

T1 - Peripheral venous lactate at admission is associated with in-hospital mortality

T2 - a prospective cohort study

AU - Barfod, Charlotte

AU - Lundstrøm, Lars Hyldborg

AU - Lauritzen, Marlene Mauson Pankoke

AU - Danker, J K

AU - Sölétormos, György

AU - Forberg, Jakob Lundager

AU - Berlac, P A

AU - Lippert, F K

AU - Antonsen, K.

AU - Lange, K H W

N1 - © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Background The prognostic value of blood lactate as a predictor of adverse outcome in the acutely ill patient is unclear. The aim of this study was to investigate if a peripheral venous lactate measurement, taken at admission, is associated with in-hospital mortality in acutely ill patients with all diagnosis. Furthermore, we wanted to investigate if the test improves a triage model in terms of predicting in-hospital mortality. Methods We retrieved a cohort of 2272 adult patients from a prospectively gathered acute admission database. We performed regression analysis to evaluate the association between the relevant covariates and the outcome measure: in-hospital mortality. Results Lactate as a continuous variable was a risk for in-hospital mortality with an odds ratio (OR) of 1.40 [95% confidence interval (CI) 1.25-1.57, P < 0.0001]. OR for in-hospital mortality increased with increasing lactate levels from 2.97 (95% CI 1.55-5.72, P < 0.001) for lactate between 2 mmol/l and 4 mmol/l, to 7.77 (95% CI 3.23-18.66, P < 0.0001) for lactate > 4 mmol/l. If the condition was non-compensated (i.e. pH < 7.35), OR for in-hospital mortality increased to 19.99 (7.26-55.06, P < 0.0001). Patient with a blood lactate at 4 mmol/l or more had a risk of in-hospital mortality equivalent to the patients in the most urgent triage category. Conclusion We found elevated admission peripheral venous lactate to be independently associated with in-hospital mortality in the acutely ill patient admitted to the emergency department. Patients with a lactate > 4 mmol/l at hospital admission should be considered triaged to the most urgent triage category.

AB - Background The prognostic value of blood lactate as a predictor of adverse outcome in the acutely ill patient is unclear. The aim of this study was to investigate if a peripheral venous lactate measurement, taken at admission, is associated with in-hospital mortality in acutely ill patients with all diagnosis. Furthermore, we wanted to investigate if the test improves a triage model in terms of predicting in-hospital mortality. Methods We retrieved a cohort of 2272 adult patients from a prospectively gathered acute admission database. We performed regression analysis to evaluate the association between the relevant covariates and the outcome measure: in-hospital mortality. Results Lactate as a continuous variable was a risk for in-hospital mortality with an odds ratio (OR) of 1.40 [95% confidence interval (CI) 1.25-1.57, P < 0.0001]. OR for in-hospital mortality increased with increasing lactate levels from 2.97 (95% CI 1.55-5.72, P < 0.001) for lactate between 2 mmol/l and 4 mmol/l, to 7.77 (95% CI 3.23-18.66, P < 0.0001) for lactate > 4 mmol/l. If the condition was non-compensated (i.e. pH < 7.35), OR for in-hospital mortality increased to 19.99 (7.26-55.06, P < 0.0001). Patient with a blood lactate at 4 mmol/l or more had a risk of in-hospital mortality equivalent to the patients in the most urgent triage category. Conclusion We found elevated admission peripheral venous lactate to be independently associated with in-hospital mortality in the acutely ill patient admitted to the emergency department. Patients with a lactate > 4 mmol/l at hospital admission should be considered triaged to the most urgent triage category.

KW - Acidosis, Lactic

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Female

KW - Hospital Mortality

KW - Humans

KW - Lactic Acid

KW - Male

KW - Middle Aged

KW - Odds Ratio

KW - Predictive Value of Tests

KW - Prognosis

KW - Prospective Studies

KW - Risk Assessment

KW - Triage

KW - Young Adult

U2 - 10.1111/aas.12503

DO - 10.1111/aas.12503

M3 - Journal article

C2 - 25786680

SN - 0001-5172

VL - 59

SP - 514

EP - 523

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 4

ER -