Lactate POCT in mobile intensive care units for septic patients? A comparison of capillary blood method versus venous blood and plasma-based reference methods

Léguillier, Teddy; Jouffroy, Romain; Boisson, Margaux; Boussaroque, Agathe; Chenevier‐Gobeaux, Camille; Chaabouni, Tarek; Vivien, Benoît; Nivet-Antoine, Valérie; Beaudeux, Jean-Louis

doi:10.1016/j.clinbiochem.2018.03.006

Cited by 30 publications

(16 citation statements)

References 13 publications

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“…12 The PhEMS are implementing in their operating procedures systems that allow responders to discriminate the surgical time, such as point-of-care ultrasound (POCUS) 13,14 or point-of-care testing (POCT). [15][16][17][18] However, this equipment implies a significant economic effort and technically requires prior learning to ensure good diagnostic performance.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Martin-Rodríguez

López-Izquierdo

Vegas

et al. 2019

Prehosp. Disaster med.

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Introduction:In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.Hypothesis/Problem:The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.Methods:This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.Results:From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).Conclusion:Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).

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Section: Introductionmentioning

confidence: 99%

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Martin-Rodríguez

López-Izquierdo

Vegas

et al. 2019

Prehosp. Disaster med.

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“…Interestingly, blood lactate was approved as an in-hospital prognostic biomarker in the severity assessment of sepsis [ 14 , 15 , 16 ]. Moreover, a previous study reported the reliability and transferability of blood lactate measurements between central laboratory analyzers and point-of-care testing [ 18 ]. Using a mobile device to assess blood lactate level in a pre-hospital setting, we showed that lactatemia is a strong predictor of worse clinical outcomes in patients with SS.…”

Section: Discussionmentioning

confidence: 99%

“…Blood lactate levels were measured at the time of first contact between the patients and the MICU using a point of care medical device (StatStrip ® Lactates, Nova Biomedical, Waltham, MA, USA). A previous study has demonstrated the comparability and transferability between this medical device and the central laboratory analyzers [ 18 ]. A sequential organ failure assessment (SOFA) score [ 21 ] and a simplified acute physiology score (SAPS 2) [ 22 ] were calculated 24 h after ICU admission.…”

Section: Methodsmentioning

confidence: 99%

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Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study

Jouffroy

Léguillier

Gilbert

et al. 2020

JCM

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Background: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, the clinical picture alone is not sufficient for assessing disease severity and outcomes. Because blood lactate level is included in the clinical criteria of SS it should be considered to improve the assessment of its severity. This study aims to investigate the relationship between pre-hospital blood lactate level and 30-day mortality in patients with SS. Methods: From 15 April 2017 to 15 April 2019, patients with SS requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were prospectively included in the LAPHSUS study, an observational, non-randomized controlled study. Pre-hospital blood lactate levels were measured at the time of first contact between the patients and the MICU. Results: Among the 183 patients with septic shock requiring action by the MICU drawn at random from LAPHSUS study patients, six (3%) were lost to follow-up on the 30th day and thus 177 (97%) were analyzed for blood lactate levels (mean age 70 ± 14 years). Pulmonary, urinary and digestive infections were probably the cause of the SS in respectively 58%, 21% and 11% of the cases. The 30-day overall mortality was 32%. Mean pre-hospital lactatemia was significantly different between patients who died and those who survived (respectively 7.1 ± 4.0 mmol/L vs. 5.9 ± 3.5 mmol/L, p < 10−3). Using Cox regression analysis adjusted for potential confounders we showed that a pre-hospital blood lactate level ≥ 4 mmol/L significantly predicted 30-day mortality in patients with SS (adjusted hazard ratio = 2.37, 95%CI (1.01–5.57), p = 0.04). Conclusion: In this study, we showed that pre-hospital lactatemia predicts 30-day mortality in patients with septic shock handled by the MICU. Further studies will be needed to evaluate if pre-hospital lactatemia alone or combined with clinical scores could affect the triage decision-making process for those patients.

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“…Prehospital lactate measurements became available to AAKSS HEMS teams as an adjunct to clinical assessment in July 2017 using the NOVA StatStrip® Biomedical Xpress™ Point of care (POCT) Lactate Meter system [9,10]. Current AAKSS Standard Operating Procedures (SOP), recommend lactate measurement in all patients with suspected major hemorrhage.…”

Section: Lactate Measurementmentioning

confidence: 99%

Determinants of prehospital lactate in trauma patients: a retrospective cohort study

Avest¹,

Griggs²,

Wijesuriya³

et al. 2020

BMC Emerg Med

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Background: Point of care serum lactate measurement is emerging as an adjunct to prehospital clinical assessment and has the potential to guide triage and advanced treatment decision-making. In this study we aimed to assess which factors potentially affect prehospital lactate levels. Methods: We performed a retrospective cohort study of all trauma patients attended by the Air Ambulance, Kent, Surrey & Sussex (AAKSS) between July 2017 and April 2018 in whom a pre-hospital lactate was measured. Lactate was measured before AAKSS treatments were commenced, but generally after prehospital treatment by ground ambulance crews was initiated. Primary endpoint of interest was the association of various patient-and treatment characteristics with prehospital lactate levels. Results: During the study period, lactate was measured in 156 trauma patients. Median lactate was 3.0 [2.0-4.1] mmol/l. Patients with an elevated lactate more often had deranged indices of end organ perfusion-and oxygenation (shock index 0.80 [0.58-1.03] vs 0.61 [0.40-0.82], p < 0.001, SpO 2 96 [89-100%] vs 98 [96-100%], p = 0.025). They more often suffered from head injuries (62% vs 41%, p = 0.008), and received less analgesia prior to arrival of the AAKSS team (51.6% vs 67.2%, p = 0.03). In multivariate analysis, indices of end organ perfusion-and oxygenation only explained 15% of the variation in lactate levels. Conclusions: Prehospital lactate levels are not solely associated with indices of end organ perfusion-and oxygenation. Injury type, treatments given on scene and many other (unmeasured) factors likely play an important role as well. This should be taken into account when lactate is used in clinical algorithms to guide prehospital triage or treatment.

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Lactate POCT in mobile intensive care units for septic patients? A comparison of capillary blood method versus venous blood and plasma-based reference methods

Cited by 30 publications

References 13 publications

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study

Determinants of prehospital lactate in trauma patients: a retrospective cohort study

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