Effect of different pre-analytical conditions on plasma lactate concentration

Rako, Ivana; Mlinarić, Ana; Dozelencic, Monika; Juroš, Gordana Fressl; Rogić, Dunja

doi:10.11613/bm.2018.020701

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Rapid recognition of sepsis is of paramount importance, since it allows early treatment and reduces mortality [ 20 ]. Lactate concentrations increase with decreasing tissue perfusion due to anaerobic cellular respiration, making lactate an early warning indicator for directly assessing of shock severity and mortality rates [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Blood-gas vs. Central-Laboratory analyzers: interchangeability and reference intervals for sodium, potassium, glucose, lactate and hemoglobin

Kocijančić

Bernhard

Ludwig-Kraus

2021

Heliyon

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Section: Discussionmentioning

confidence: 99%

Blood-gas vs. Central-Laboratory analyzers: interchangeability and reference intervals for sodium, potassium, glucose, lactate and hemoglobin

Kocijančić

Bernhard

Ludwig-Kraus

2021

Heliyon

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“…This may delay the results for clinical use, require recollection of patients, increases the cost of personnel time and consumables, and certainly may increase the risk for patient harm. 7 Several studies have examined stability of lactate in whole blood, plasma or serum, with either heparin or fluorinated collection tubes 7,9,10,[12][13][14] ; however, the conditions outlined in these studies failed to fully reflect the delayed timing conditions experienced by some remote/ rural laboratories or nursing stations with pre-analytical constraints (e.g. not having centrifuges for rapid separation of plasma from cells).…”

Section: Discussionmentioning

confidence: 99%

“…Blood collection devices containing lithium heparin or sodium fluoride/ potassium oxalate (NaF/KOx) additives are commonly used and are usually delivered to the laboratory at room temperature or on ice, and are usually centrifuged within 15-30 min from collection. [9][10][11] However, this practice is not standardized, and some laboratories have even extended the allowed turnaround time (TAT) interval to 45 min or 1 h, and some even longer, without having the appropriate evidence to support this practice. Furthermore, many large tertiary care centres are also reference sites, performing referred-in work from remote laboratories or clinical stations that may not have the appropriate pre-analytical equipment or technical oversight to process blood specimens (e.g.…”

Section: Introductionmentioning

confidence: 99%

Long term stability of lactate in uncentrifuged sodium fluoride/potassium oxalate blood collection tubes

Stevic,

Bolsover,

Moore

et al. 2023

Ann Clin Biochem

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Background Delayed time from collection to centrifugation may cause erroneously high lactate levels in vitro (from continued blood cell metabolism under anaerobic conditions in the collection tube) if not collected in appropriate collection devices, consequently increasing the risk for inappropriate patient care or harm. We undertook a study to determine the turnaround time for lactate testing in a tertiary care setting and also performed short- and long-term lactate stability studies in blood collected in sodium fluoride/potassium oxalate (NaF/KOx) collection tubes. Methods The hospital lab information system was mined for 6 months to determine patient samples that may have exceeded the time from collection-to-receival in lab of 15-min. Lactate stability was evaluated in unspun NaF/KOx collection tubes at 15 min intervals for to 2 h; and separately at 2, 6, 12, 24, and 48-h post-collection. Results A total of 8,929 plasma samples were collected in 6 months, and 1/3 were not received in the lab within 15 min from collection. In NaF/KOx additive, lactate levels had minor increases over 2 h, and incremental increases at an average rate of 0.0035 mmol/L/h over 48 h with maximum increase of 9.8% at 48 h. However, the average change across all time points were within local allowable performance goals (at ≤4 mmol/L ± 0.5 mmol/L; at >4 mmol/L ± 12%). Conclusion A small proportion of lactate specimens may experience delay in processing. Although lactate levels may incrementally increase over 48-h at room temperature in unspun NaF/KOx collection tubes, the changes may not be clinically impactful.

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“…Lactate was measured by point-of-care testing (StatStrip Xpress lactate, Nova Biomedical), as lactate cannot be measured reliably from stored blood samples. 18 The venous blood samples were stored at -70⁰C for later measurements of CRP and PCT. All patients received care as usual.…”

Section: Methodsmentioning

confidence: 99%

Development and external validation of a new clinical prediction model for early recognition of sepsis in adult patients in primary care: a diagnostic study

Loots

Smits

Hopstaken³

et al. 2022

Br J Gen Pract

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Background: Recognising patients who need immediate hospital treatment for sepsis while simultaneously limiting unnecessary referrals is challenging for GPs. Aim: Develop and validate a sepsis prediction model for adult patients in primary care. Design and setting: Prospective cohort study in four out-of-hours primary care services in the Netherlands, between June 2018 and March 2020. Method: Acutely ill adult patients who received home visits were included. Nine clinical variables were candidate predictors, next to the biomarkers C-reactive protein, procalcitonin, and lactate. The primary endpoint was sepsis within 72 hours of inclusion, as established by an expert panel. Multivariable logistic regression with backwards selection was used to design an optimal model with continuous clinical variables. The added value of the biomarkers was evaluated. Subsequently, a simple model using single cutoff points of continuous variables was developed and externally validated in two emergency department populations. Results: 357 patients were included with a median age of 80 years, of which 151 (42%) were diagnosed with sepsis. A model based on a simple count of one point for each of six variables (age>65 years; temperature>38°C; systolic blood pressure≤110 mmHg; heart rate>110/min; saturation≤95%; altered mental status) had good discrimination and calibration (C statistic of 0.80 [95% CI 0.75-0.84]; Brier score 0.175). Biomarkers did not improve the performance of the model and were therefore not included. The model was robust during external validation. Conclusion: Based on this GP out-of-ours population, a simple model can accurately predict sepsis in acutely ill adult patients using readily available clinical parameters.

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Effect of different pre-analytical conditions on plasma lactate concentration

Cited by 5 publications

References 20 publications

Blood-gas vs. Central-Laboratory analyzers: interchangeability and reference intervals for sodium, potassium, glucose, lactate and hemoglobin

Blood-gas vs. Central-Laboratory analyzers: interchangeability and reference intervals for sodium, potassium, glucose, lactate and hemoglobin

Long term stability of lactate in uncentrifuged sodium fluoride/potassium oxalate blood collection tubes

Development and external validation of a new clinical prediction model for early recognition of sepsis in adult patients in primary care: a diagnostic study

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