Peripheral venous lactate levels substitute arterial lactate levels in the emergency department

Abstract

Background Arterial lactate (AL) level is an important predictor of patient prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. However, if the AL range can be predicted from PVL, PVL may be an alternative method for predicting patient prognosis, and the risk of arterial puncture complications with AL may be reduced. This could be a safe and rapid test method. Methods This was a retrospective observational study of 125 cases in which blood gas analysis was performed on both arterial and venous blood with an infectious disease in an emergency department. Spearman’s rank correlation coefficient (r) and Bland–Altman analyses were performed. Sensitivity, specificity, and area under the curve (AUC) were calculated for PVL to predict AL < 2 mmol/L or < 4 mmol/L. Results The median [interquartile range] AL and PVL were 1.82 [1.25–2.46] vs. 2.08 [1.57–3.28], respectively, r was 0.93 (p < 0.0001), and a strong correlation was observed; however, Bland–Altman analysis showed disagreement. When AL < 2 mmol/L was used as the outcome, AUC was 0.970, the PVL cutoff value was 2.55 mmol/L, sensitivity was 85.71%, and specificity was 96.05%. If PVL < 2 mmol/L was the outcome, the sensitivity for AL < 2mmol/L was 100%, and for PVL levels ≥ 3 mmol/L, the specificity was 100%. When AL < 4 mmol/L was used as the outcome, AUC was 0.967, the PVL cutoff value was 3.4 mmol/L, sensitivity was 100%, and specificity was 85.84%. When PVL < 3.5 mmol/L was the outcome, the sensitivity for AL < 4 mmol/L was 100%, and for PVL levels ≥ 4 mmol/L, the specificity was 93.81%. Conclusions This study revealed that PVL and AL levels in the same critically ill patients did not perfectly agree with each other but were strongly correlated. Furthermore, the high accuracy for predicting AL ranges from PVL levels explains why PVL levels could be used as a substitute for AL level ranges.

The Predictive Role of Lactate in the Emergency Department in Patients with Severe Dyspnea

“…Exclusion of patients with SpO 2 > 97% resulted in a better correlation between those data [ 26 ]. Studies also revealed that the arterial lactate level and the peripheral venous lactate level are not perfectly identical, but they are strongly correlated with each other [ 27 ]. Furthermore, scientists have found not only the peripheral venous but also central venous pH, bicarbonate, base excess, and lactate values have almost 95% limit of agreement with arterial blood samples [ 28 ].…”

Sepsis best practices

“…11 Some suggest arterial lactate levels may be slightly higher than venous levels but multiple studies suggest a strong correlation. 37,38 The SEP-1 bundle measures do not differentiate between arterial or venous specimens. 11 The normal lactate level range is 0.6 to 2.2 mmol/L.…”

Peripheral venous lactate levels substitute arterial lactate levels in the emergency department

“…Elevated lactate levels in studied cases with certain diseases can be linked to morbidity & mortality. When lactate levels had been greater than four mmol/L in individuals with shock that might not be distinguished based on cause, prognosis had been poor (1).…”

“…To determine arterial lactate levels in individuals with severe diseases, blood gas analyses have been repeated. Nevertheless, this testing necessitates catheterization (artery line placement) & arterial puncture, which are invasive procedures that carry risk of consequences (2).…”

“…As substitute for arterial blood gas analysis in emergency department, venous blood gas analysis has been typically carried out to lower risk of complications from arterial puncture. But due to discrepancies among venous & arterial blood gas analyses, it's important to assess how closely analyses' values line up & whether venous blood gas analysis may take place of arterial blood gas analysis (2).…”