Prehospital lactate clearance is associated with reduced mortality in patients with septic shock

Jouffroy, Romain; Léguillier, Teddy; Gilbert, Basile; Tourtier, Jean Pierre; Bloch-Laine, Emmanuel; Ecollan, Patrick; Bounes, Vincent; Boularan, Josiane; Gueye-Ngalgou, Papa; Nivet-Antoine, Valérie; Beaudeux, Jean-Louis; Vivien, Benoît

doi:10.1016/j.ajem.2020.10.018

Cited by 13 publications

(7 citation statements)

References 43 publications

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“… 9 In previous studies, lactate clearance was reported to have prognostic value in heterogeneous populations such as patients with sepsis, trauma or respiratory failure, and increased lactate clearance was found to be correlated with lower risk of organ failure and mortality. 19–21 Arnold et al depicted that lactate clearance of at least 10% at 6, 24 and 48 hours was independently associated with the mortality of patients with sepsis after adjusting for critically ill status or severity. 22 Another study also identified the prognostic roles of lactate clearance at 6, 24 and 48 hours as well as the importance of delayed lactate clearance at 24 hours and 48 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Relative to lactate level, lactate clearance shows the relative change in lactate levels over time, which can help the clinicians timely modify the treatments to patients 9. In previous studies, lactate clearance was reported to have prognostic value in heterogeneous populations such as patients with sepsis, trauma or respiratory failure, and increased lactate clearance was found to be correlated with lower risk of organ failure and mortality 19–21. Arnold et al depicted that lactate clearance of at least 10% at 6, 24 and 48 hours was independently associated with the mortality of patients with sepsis after adjusting for critically ill status or severity 22.…”

Section: Discussionmentioning

confidence: 99%

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Association of lactate detection with in-hospital mortality in critically ill patients with acute myocardial infarction: a retrospective cohort study

Chen

Xing

et al. 2023

BMJ Open

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ObjectivesTo assess the associations of lactate level or lactate clearance at different time points with in-hospital mortality in critically ill patients with acute myocardial infarction (AMI).DesignA cohort study.SettingThe Medical Information Mart for Intensive Care III database.Participant490 AMI patients.InterventionNone.Primary and secondary outcome measuresIn-hospital mortality of patients.ResultsIn total, 120 (24.49%) patients died at the end of follow-up. After adjusting for confounders, increased risk of in-hospital mortality in patients with AMI was observed in those with high lactate level (24 hours) (HR=1.156, 95%CI: 1.002 to 1.333). Increased lactate clearance (24 hours) was correlated with a decreased risk of in-hospital mortality in patients with AMI (HR=0.995, 95% CI: 0.994 to 0.997). The area under the curves (AUCs) of lactate level (24 hours) and lactate clearance (24 hours) were 0.689 (95% CI: 0.655 to 0.723) and 0.672 (95% CI: 0.637 to 0.706), respectively. The AUC of lactate level (24 hours) and lactate clearance (24 hours) was higher than lactate level (baseline).ConclusionsIncreased lactate level (24 hours) was associated with an elevated risk of in-hospital mortality in patients with AMI and increased lactate clearance (24 hours) was correlated with a decreased risk of in-hospital mortality in patients with AMI despite the age and genders.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of lactate detection with in-hospital mortality in critically ill patients with acute myocardial infarction: a retrospective cohort study

Chen

Xing

et al. 2023

BMJ Open

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“…Under specific physio-pathological circumstances, e.g., sepsis, trauma, poisonings, burns, and acute cardio-vascular diseases, hyperlactatemia (> 4 mmol/L) is linked to impaired outcomes. In contrast, lactate clearance is a robust reporter of metabolic up-regulation [ 28 , 29 ]. Creatinine is the second endpoint included in the score.…”

Section: Discussionmentioning

confidence: 99%

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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“…Os estudos encontrados na literatura sobre os desfechos dos pacientes atendidos no pré-hospitalar móvel referem-se a intervenções específicas realizadas durante o atendimento. Pode-se citar, dentre outros, o atendimento a pacientes com choque séptico (30) , hipotermia após parada cardiorrespiratória (31) e sobrevida após parada cardiorrespiratória (32) . Todos eles associam a sobrevida do paciente com as intervenções realizadas no ambiente pré-hospitalar, deixando uma lacuna de evidências quanto à evolução dos pacientes atendidos eao desfecho no ambiente hospitalar.…”

Section: Discussionunclassified

Perfil, evolução e desfecho dos pacientes atendidos pelo serviço de atendimento móvel de urgência1/Profile, evolution and outcome of patients served by the mobile emergency care service1

et al. 2021

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Objetivo: analisar perfil, evolução e desfecho dos pacientes atendidos pelo SAMU 192. Método: estudo transversal, exploratório e descritivo. A amostra constou dados de 600 pacientes adultos, atendidos no ano de 2015 pelo SAMU e encaminhados para outro serviço de saúde. Realizou-se análise descritiva para identificar o perfil da população, a evolução e o desfecho intra-hospitalar; teste de correlação entre o tempo resposta no serviço pré-hospitalar e o tempo de internação; e regressão logística múltipla entre o tempo resposta e o desfecho. Utilizou-se p<0,05 como nível de significância. Resultados: predominaram o atendimento de ocorrências clínicas, o sexo masculino e a média de idade de 55,5 anos. Após o atendimento pré-hospitalar, 50,2% dos pacientes permaneceram em observação e 34,8% precisaram de internação hospitalar. O tempo resposta pré-hospitalar apresentou correlação positiva com o tempo de internação. O principal desfecho foi a alta médica, sendo que 41% deles foram encaminhados para continuidade do tratamento. Conclusão: a análise mostrou um perfil de atendimentos a pacientes com idade média de 55 anos e acometidos por doenças de natureza clínica que necessitaram de encaminhamento a uma unidade de saúde, permanecendo em observação hospitalar por até 12h. Esses resultados são importantes para o embasamento de protocolos de fluxo assistencial na RUE, a fim de diminuir a sobrecarga dos serviços terciários.

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Prehospital lactate clearance is associated with reduced mortality in patients with septic shock

Cited by 13 publications

References 43 publications

Association of lactate detection with in-hospital mortality in critically ill patients with acute myocardial infarction: a retrospective cohort study

Association of lactate detection with in-hospital mortality in critically ill patients with acute myocardial infarction: a retrospective cohort study

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

Perfil, evolução e desfecho dos pacientes atendidos pelo serviço de atendimento móvel de urgência1/Profile, evolution and outcome of patients served by the mobile emergency care service1

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