Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Martin-Rodríguez, Francisco; López-Izquierdo, Raúl; Medina-Lozano, Elena; Rabbione, Guillermo Ortega; Vegas, Carlos Del Pozo; Rodríguez, Virginia Carbajosa; Villamor, Miguel Ángel Castro; Sánchez-Soberón, Irene; Sanz-García, Áncor

doi:10.1111/eci.13341

Cited by 21 publications

(25 citation statements)

References 44 publications

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“…25,26 Severe acidemia can lead to cardiovascular collapse because of hydrogen ion binding to cellular proteins, impairing their functions, and it may be associated with mortality. 27 Moreover, the findings on the strong correlation of elevated lactate levels and long-term mortality are consistent with other studies. Serum lactate level rises with both accelerated glycolysis and tissue hypoxia and is known to be a predictor of mortality in sepsis, polytrauma, OHCA, and neurological problems.…”

Section: Discussionsupporting

confidence: 90%

Long-Term Mortality in Patients Transferred by Emergency Medical Services: Prospective Cohort Study

Gambara

Sanz-García

Conty

et al. 2023

Prehosp. Disaster med.

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Objective: This study aimed to determine the long-term mortality (one-year follow-up) associated with patients transferred by Emergency Medical Services (EMS), and to reveal the determinants (causes and risk factors). Methods: This was a multicenter, prospective, observational, controlled, ambulance-based study of adult patients transferred by ambulance to emergency departments (EDs) from October 2019 through July 2021 for any cause. A total of six Advanced Life Support (ALS) units, 38 Basic Life Support (BLS) units, and five hospitals from Spain were included. Physiological, biochemical, demographic, and reasons for transfer variables were collected. A longitudinal analysis was performed to determine the factors associated to long-term mortality (any cause). Results: The final cohort included 1,406 patients. The one-year mortality rate was 21.6% (n = 304). Mortality over the first two days reached 5.2% of all the patients; between Day 2 and Day 30, reached 5.3%; and between Day 31 and Day 365, reached 11.1%. Low Glasgow values, elevated lactate levels, elevated blood urea nitrogen (BUN) levels, low oxygen saturation, high respiratory rate, as well as being old and suffering from circulatory diseases and neurological diseases were risk factors for long-term mortality. Conclusion: The quick identification of patients at risk of long-term worsening could provide an opportunity to customize care through specific follow-up.

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Section: Discussionsupporting

confidence: 90%

Long-Term Mortality in Patients Transferred by Emergency Medical Services: Prospective Cohort Study

Gambara

Sanz-García

Conty

et al. 2023

Prehosp. Disaster med.

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“…Swan et al [ 23 ] reported an AUC for unplanned-ICU admission and mortality of 0.676 and 0.633, respectively, albeit with a relatively limited cohort. Martín et al [ 3 ] reported an AUC of 0.867 for 2-day mortality. Figueira et al [ 24 ] developed a score for use in patients listed for liver transplantation (including lactate and creatinine), with an AUC of 0.835 to detect in-hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

“…In this respect, the decision curve analysis of our score, with a net benefit greater than “All” and “None” strategies, showed its clinical applicability. Lactate is one of the three biomarkers that make up the score and plays a well-studied role in risk-stratification in prehospital care [ 3 , 23 ]. Similarly, elevated lactate levels correlate with increased morbidity–mortality and a significant excess of in-patient hospital and non-unplanned ICU-admissions [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

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Derivation and validation of a blood biomarker score for 2-day mortality prediction from prehospital care: a multicenter, cohort, EMS-based study

et al. 2023

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Identifying potentially life-threatening diseases is a key challenge for emergency medical services. This study aims at examining the role of different prehospital biomarkers from point-of-care testing to derive and validate a score to detect 2-day in-hospital mortality. We conducted a prospective, observational, prehospital, ongoing, and derivation—validation study in three Spanish provinces, in adults evacuated by ambulance and admitted to the emergency department. A total of 23 ambulance-based biomarkers were collected from each patient. A biomarker score based on logistic regression was fitted to predict 2-day mortality from an optimum subset of variables from prehospital blood analysis, obtained through an automated feature selection stage. 2806 cases were analyzed, with a median age of 68 (interquartile range 51–81), 42.3% of women, and a 2-day mortality rate of 5.5% (154 non-survivors). The blood biomarker score was constituted by the partial pressure of carbon dioxide, lactate, and creatinine. The score fitted with logistic regression using these biomarkers reached a high performance to predict 2-day mortality, with an AUC of 0.933 (95% CI 0.841–0.973). The following risk levels for 2-day mortality were identified from the score: low risk (score < 1), where only 8.2% of non-survivors were assigned to; medium risk (1 ≤ score < 4); and high risk (score ≥ 4), where the 2-day mortality rate was 57.6%. The novel blood biomarker score provides an excellent association with 2-day in-hospital mortality, as well as real-time feedback on the metabolic-respiratory patient status. Thus, this score can help in the decision-making process at critical moments in life-threatening situations.

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“…The search identified 1862 articles, of which 53 met the criteria for the first phase. After the second phase, 19 papers [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] were included in the final evaluation. The total study population in the 19 studies is 34261 participants.…”

Section: Lactatementioning

confidence: 99%

The potential of point-of-care diagnostics to optimise prehospital trauma triage: a systematic review of literature

Stojek

Bieler

Neubert

et al. 2023

Eur J Trauma Emerg Surg

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Purpose In the prehospital care of potentially seriously injured patients resource allocation adapted to injury severity (triage) is a challenging. Insufficiently specified triage algorithms lead to the unnecessary activation of a trauma team (over-triage), resulting in ineffective consumption of economic and human resources. A prehospital trauma triage algorithm must reliably identify a patient bleeding or suffering from significant brain injuries. By supplementing the prehospital triage algorithm with in-hospital established point-of-care (POC) tools the sensitivity of the prehospital triage is potentially increased. Possible POC tools are lactate measurement and sonography of the thorax, the abdomen and the vena cava, the sonographic intracranial pressure measurement and the capnometry in the spontaneously breathing patient. The aim of this review was to assess the potential and to determine diagnostic cut-off values of selected instrument-based POC tools and the integration of these findings into a modified ABCDE based triage algorithm. Methods A systemic search on MEDLINE via PubMed, LIVIVO and Embase was performed for patients in an acute setting on the topic of preclinical use of the selected POC tools to identify critical cranial and peripheral bleeding and the recognition of cerebral trauma sequelae. For the determination of the final cut-off values the selected papers were assessed with the Newcastle–Ottawa scale for determining the risk of bias and according to various quality criteria to subsequently be classified as suitable or unsuitable. PROSPERO Registration: CRD 42022339193. Results 267 papers were identified as potentially relevant and processed in full text form. 61 papers were selected for the final evaluation, of which 13 papers were decisive for determining the cut-off values. Findings illustrate that a preclinical use of point-of-care diagnostic is possible. These adjuncts can provide additional information about the expected long-term clinical course of patients. Clinical outcomes like mortality, need of emergency surgery, intensive care unit stay etc. were taken into account and a hypothetic cut-off value for trauma team activation could be determined for each adjunct. The cut-off values are as follows: end-expiratory CO2: < 30 mm/hg; sonography thorax + abdomen: abnormality detected; lactate measurement: > 2 mmol/L; optic nerve diameter in sonography: > 4.7 mm. Discussion A preliminary version of a modified triage algorithm with hypothetic cut-off values for a trauma team activation was created. However, further studies should be conducted to optimize the final cut-off values in the future. Furthermore, studies need to evaluate the practical application of the modified algorithm in terms of feasibility (e.g. duration of application, technique, etc.) and the effects of the new algorithm on over-triage. Limiting factors are the restriction with the search and the heterogeneity between the studies (e.g. varying measurement devices, techniques etc.).

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Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Cited by 21 publications

References 44 publications

Long-Term Mortality in Patients Transferred by Emergency Medical Services: Prospective Cohort Study

Long-Term Mortality in Patients Transferred by Emergency Medical Services: Prospective Cohort Study

Derivation and validation of a blood biomarker score for 2-day mortality prediction from prehospital care: a multicenter, cohort, EMS-based study

The potential of point-of-care diagnostics to optimise prehospital trauma triage: a systematic review of literature

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