Association of Clinical Hypoperfusion Variables With Lactate Clearance and Hospital Mortality

Londoño, Jessica; Niño, César Daniel; Díaz, J. Pedregosa; Morales, Carlos; León, Jimmy; Bernal, Elisa; Vargas, César; Bonilla‐Mejía, Leonardo; Hincapié, Carolina; Ascuntar, Johana; León, Alba; Jaimes, Fabián

doi:10.1097/shk.0000000000001066

Cited by 21 publications

(15 citation statements)

References 30 publications

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“…Plasma lactate concentration is recognized as a marker of hypoperfusion and other serious conditions, as such it is not surprising that hyperlactatemia is associated with poorer patient outcomes. There is some evidence that hyperlactatemia maybe a better indicator of hypoperfusion than traditional markers such as physical examination findings, blood pressure measurement, and urine output 31–33 . Tissue hypoperfusion can persist despite normalization of these variables, a situation known as occult or cryptic shock.…”

Section: Discussionmentioning

confidence: 99%

Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012 – December 2016): 4863 cases

Saint-Pierre

Hopper

Epstein

2021

J Vet Emergen Crit Care

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Objective To determine the prognostic significance of plasma lactate concentration, plasma lactate clearance, and delta lactate in dogs and cats presented to an emergency room (ER). Design Retrospective study. Setting University teaching hospital. Animals A total of 8,321 animals with a plasma lactate concentration measured with 4,863 presenting to the ER and 1,529 dogs and 444 cats having a measurement within 4 hours of admission. Interventions None. Measurements and main results Plasma lactate concentration of dogs and cats presented to a university teaching hospital was retrospectively evaluated. Of dogs and cats with a plasma lactate concentration measured within 4 hours of admission to the ER, hyperlactatemia was common, and the prevalence of hyperlactatemia for dogs 78% (361/462) and cats 67% (78/116) was highest when evaluated within the first 30 minutes following admission. The distribution of patient's plasma lactate concentration was significantly higher in non‐survivors compared to survivors at all time points evaluated (P0.28em<0.28em$\; < \;$0.001). Both lactate clearance (P = 0.010) and delta lactate (P = 0.013) were significantly different between survivors and nonsurvivors. A delta lactate > 4.5 mmol/L was 100% (95% CI: 95 to 100%) specific for nonsurvival in patients with hyperlactatemia measured within 1 hour of admission to the ER. The most common cause of hyperlactatemia was shock in dogs (24%) and urinary tract diseases in cats (22%). Shock was associated with the highest mortality rate in both dogs (61%) and cats (77%). Hyperlactatemia was significantly associated with increased mortality for dogs with shock (P = 0.001), respiratory diseases (P = 0.022), diabetes mellitus (P = 0.018), and liver dysfunction (P = 0.006). Conclusions Hyperlactatemia was associated with mortality in both dogs and cats when measured at any time point in the 4 hours following admission to the ER. Serial lactate measurement may also be a valuable tool to guide clinical management decisions.

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Section: Discussionmentioning

confidence: 99%

Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012 – December 2016): 4863 cases

Saint-Pierre

Hopper

Epstein

2021

J Vet Emergen Crit Care

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“…To assess this adequacy, clinical examination has still a limited value. Signs of skin hypoperfusion do not reliably detect tissue hypoxia (4). Urine output may reflect the kidney perfusion, but it might be altered by many other factors during shock.…”

Section: Introductionmentioning

confidence: 99%

How can CO2-derived indices guide resuscitation in critically ill patients?

Gavelli¹,

Teboul²,

Monnet³

2019

J. Thorac. Dis

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Assessing the adequacy of oxygen delivery with oxygen requirements is one of the key-goal of haemodynamic resuscitation. Clinical examination, lactate and central or mixed venous oxygen saturation (S v O 2 and S cv O 2 , respectively) all have their limitations. Many of them may be overcome by the use of the carbon dioxide (CO 2)-derived variables. The venoarterial difference in CO 2 tension ("ΔPCO 2 " or "PCO 2 gap") is not an indicator of anaerobic metabolism since it is influenced by the oxygen consumption. By contrast, it reliably indicates whether blood flow is sufficient to carry CO 2 from the peripheral tissue to the lungs in view of its clearance: it, thus, reflects the adequacy of cardiac output with the metabolic condition. The ratio of the PCO 2 gap with the arteriovenous difference of oxygen content (PCO 2 gap/C a-v O 2) might be a marker of anaerobiosis. Conversely to S v O 2 and S cv O 2 , it remains interpretable if the oxygen extraction is impaired as it is in case of sepsis. Compared to lactate, it has the main advantage to change without delay and to provide a real-time monitoring of tissue hypoxia.

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“…This analysis was performed using three prospective cohort studies developed between 2013 and 2016 in five emergency departments of the city of Medellín: Hospital Universitario San Vicente Fundación (560 adult inpatient beds and 45 ICU beds in 4 units), the University Health Services Provider Institution IPS Universitaria Clinica León XIII (450 adult inpatient beds and 24 ICU beds in 2 units), Hospital Pablo Tobón Uribe (360 adult inpatient beds and 40 UCI beds in 3 units), Hospital General de Medellín (442 beds) and Clínica Las Américas (304 beds) [12][13][14] . The first cohort was recruited from the emergency department of three tertiary care hospitals: Hospital Pablo Tobón Uribe, Hospital General de Medellín and Clínica Las Américas (2013-2016).…”

Section: Study Design and Settingmentioning

confidence: 99%

“…As common criteria exclusion, we found for the 3 cohorts: patients that were early discharge or referenced to another institution, and patients with do-not-resuscitate orders or terminal diseases (Annex 1). No additional exclusion criteria that had not been considered in the original studies were used in the present study (12)(13)(14).…”

Section: Participantsmentioning

confidence: 99%

“…Se realizó un análisis de tres estudios de cohorte prospectivos desarrollados entre 2013 y 2016 en cinco servicios de urgencias de la ciudad de Medellín: Hospital Universitario San Vicente Fundación (560 camas de hospitalización de adultos y 45 camas de UCI en 4 unidades), la Institución Prestadora de Servicios de Salud Universitaria IPS Universitaria Clínica León XIII (450 camas de hospitalización de adultos y 24 camas de UCI en 2 unidades), Hospital Pablo Tobón Uribe (360 camas de hospitalización de adultos y 40 camas de UCI en tres unidades), Hospital General de Medellín (442 camas) y Clínica Las Américas (304 camas) 12 - 14 . La primera cohorte se reclutó del servicio de urgencias de tres hospitales de tercer nivel: Hospital Pablo Tobón Uribe, Hospital General de Medellín y Clínica Las Américas (2013-2016).…”

Section: Materiales Y Métodosunclassified

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Validation and comparison of three mortality prediction scores in emergency department patients with community-acquired pneumonia

Hincapié¹,

Ascuntar²,

León³

et al. 2021

Colomb Med

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Background: qSOFA is a score to identify patients with suspected infection and risk of complications. Its criteria are similar to those evaluated in prognostic scores for pneumonia (CRB-65 - CURB-65), but it is not clear which is best for predicting mortality and admission to the ICU. Objective: validate and compare three scores (CURB-65, CRB-65 and qSOFA) to determine the best tool to identify emergency department patients with pneumonia who are at increased risk of mortality or intensive care unit (ICU) admission. Methods: Secondary analysis of three prospective cohorts of patients hospitalized with diagnosis of pneumonia in five hospitals in Medellin (Colombia). Validation and comparison of the score´s accuracies were performed by means of discrimination and calibration measures. Results: Cohorts 1, 2 and 3 included 158, 745 and 207 patients, with mortality rates of 32.3%, 17.2% and 18.4%, and admission to ICU was required for 52.5%, 43.5% and 25.6%, respectively. The best AUC-ROC for mortality was for CURB-65 in cohort 3 (AUC-ROC=0.67). The calibration was adequate (p>0.05) for the three scores. Conclusions: None of these scores proved to be an appropriate predictor for mortality and admission to the ICU. It is probable that the local context have modified their performance. It is necessary to validate the old ones and probably to develop new predictive models of prognosis for CAP in each country.

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Association of Clinical Hypoperfusion Variables With Lactate Clearance and Hospital Mortality

Abstract: Among patients with hypoperfusion risk or shock, no correlation was found between clinical variables and lactate. Of the set of parameters collected, lactate at admission was the only independent marker of mortality.

Cited by 21 publications

References 30 publications

Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012 – December 2016): 4863 cases

Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012 – December 2016): 4863 cases

How can CO2-derived indices guide resuscitation in critically ill patients?

Validation and comparison of three mortality prediction scores in emergency department patients with community-acquired pneumonia

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