The role of the serum lactate level at the first admission to the emergency department in predicting mortality

Şeker, Yurdagül Çetin; Bozan, Öner; Şam, Emre; Topaçoğlu, Hakan; Kalkan, Ahmet

doi:10.1016/j.ajem.2020.09.088

Cited by 10 publications

(15 citation statements)

References 15 publications

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“…Again, calprotectin displayed the highest AUROC for this endpoint compared to the other biomarkers ( Table 1 C). With regard to ICU admission, calprotectin was better than CRP and PCT (0.80 vs 0.66 and 0.60 respectively), yet inferior to lactate, although hyperlactatemia being a widely used biomarker for admitting patients to the ICU 8 . Thus, the routine in-house strategy presents a potential source of bias in favor for lactate.…”

mentioning

confidence: 99%

Outcome prediction by serum calprotectin in patients with COVID-19 in the emergency department

Bauer

Diehl-Wiesenecker

Ulke

et al. 2021

Journal of Infection

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mentioning

confidence: 99%

Outcome prediction by serum calprotectin in patients with COVID-19 in the emergency department

Bauer

Diehl-Wiesenecker

Ulke

et al. 2021

Journal of Infection

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“…Lactate levels have been a source of interest as a prognostic biomarker in emergency medicine patients for some time. Lactate levels measured during ED workup have, in other larger studies, shown a good predictive value for 10- to 60-day mortality [ 24 – 27 ]. Several differences may explain the discrepancy between these results and those of our study.…”

Section: Discussionmentioning

confidence: 99%

“…Lactate levels have been of particular interest, based on their ability to refine prediction of patients’ prognosis in the ED [ 24 – 27 ] intensive care unit (ICU) [ 28 ] or prehospital settings [ 29 , 30 ]. Among ED patients, higher rates of early mortality, particularly due to sepsis [ 31 , 32 ] and trauma [ 33 , 34 ], have been associated with high levels of lactate.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study

et al. 2022

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Objective Patients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing (POCT) in this population. The secondary objective was to assess the additional value of lactate level in predicting an early poor outcome, as compared to and combined with common clinical scores and triage scales. Methods This monocentric prospective study recruited ED patients who were over 65 years old between July 19th 2019 and June 17th 2020. Patients consulting for seizures or needing immediate assessment were excluded. POCT lactates were considered elevated if ≥ 2.5 mmol/L. A poor outcome was defined based on certain complications or therapeutic decisions. Results In total, 602 patients were included; 163 (27.1%) had elevated lactate and 44 (7.3%) had a poor outcome. There was no association between poor outcome and lactate level. Modified Early Warning Score (MEWS) was significantly associated with poor outcome, alongside National Early Warning Score (NEWS). Logistic regression also associated lactate level combined with MEWS and poor outcome. Conclusion The prevalence of elevated lactate was 27.1%. Lactate level alone or combined with different triage scales or clinical scores such as MEWS, NEWS and qSOFA was not associated with prediction of a poor outcome. MEWS alone performed best in predicting poor outcome. The usefulness of POCT lactate measurement at triage is questionable in the population of 65 and above.

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“…Some researchers suggest that when the lactate level is high, the patient's prognosis is poor [13][14][15], and there is a dose-dependent relationship between the lactate level and the risk of mortality [16,17]. In addition, there is a significant correlation between persistently high lactate levels and an increased risk of mortality [18][19][20]. Patients with higher baseline lactate levels have a higher risk of mortality, and thus, the initial lactate concentration better predicts the risk of patient mortality [21,22].…”

Section: Introductionmentioning

confidence: 99%

The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically Ill patients: a retrospective cohort study

et al. 2022

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Background The mortality rate is high in critically ill patients due to the difficulty of diagnosis and treatment. Thus, it is very important to explore the predictive value of different indicators related to prognosis in critically ill patients. Methods This was a retrospective cohort study of patients in the intensive care unit (ICU) of the Sixth People’s Hospital in Shanghai, China. A total of 1465 ICU patients had lactate values > 2.1 mmol/L at least once within 24 h of ICU admission, and arterial blood gas was monitored more than twice during the ICU stay. Results The predictive value of lactate clearance at 24 h was not high, and the sensitivity and specificity were lower. The predictive value of the lactate level at baseline and the APACHE II score was higher than that of lactate clearance at 24 h in critically ill patients. The predictive value of the lactate level at baseline combined with the APACHE II score was higher than that of the lactate level at baseline or the APACHE II score alone. In addition, the predictive value of lactate clearance at 24 h combined with the APACHE II score was also significantly higher than that of lactate clearance at 24 h or the APACHE II score alone. In particular, the area under the ROC curve reached 0.900, the predictive value was markedly higher than that of the ROC alone, and the sensitivity and specificity were better when these three indicators were combined. Conclusions The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically ill patients.

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The role of the serum lactate level at the first admission to the emergency department in predicting mortality

Cited by 10 publications

References 15 publications

Outcome prediction by serum calprotectin in patients with COVID-19 in the emergency department

Outcome prediction by serum calprotectin in patients with COVID-19 in the emergency department

Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study

The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically Ill patients: a retrospective cohort study

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