Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study

Abstract

BackgroundElevated lactate has been found to be associated with a higher mortality in a diverse patient population. The aim of the study is to investigate if initial serum lactate level is independently associated with hospital mortality for critically ill patients presenting to the Emergency Department.MethodsSingle-center, retrospective study at a tertiary care hospital looking at patients who presented to the Emergency Department (ED) between 2014 and 2016. A total of 450 patients were included in the study. Patients were stratified to lactate levels: <2 mmol/L, 2-4 mmol/L and >4 mmol/L. The primary outcome was in-hospital mortality. Secondary outcomes included 72-h hospital mortality, ED and hospital lengths of stay.ResultsThe mean age was 64.87 ± 18.08 years in the <2 mmol/L group, 68.51 ± 18.01 years in the 2-4 mmol/L group, and 67.46 ± 17.67 years in the >4 mmol/L group. All 3 groups were comparable in terms of age, gender and comorbidities except for diabetes, with the 2-4 mmol/L and >4 mmol/L groups having a higher proportion of diabetic patients. The mean lactate level was 1.42 ± 0.38 (<2 mmol/L), 2.72 ± 0.55 (2-4 mmol/L) and 7.18 ± 3.42 (>4 mmol/L). In-hospital mortality was found to be 4 (2.7%), 18(12%) and 61(40.7%) patients in the low, intermediate and high lactate groups respectively. ED and hospital length of stay were longer for the >4 mmol/L group as compared to the other groups. While adjusting for all variables, patients with intermediate and high lactate had 7.13 (CI 95% 2.22–22.87 p = 0.001) and 29.48 (CI 95% 9.75–89.07 p = <0.001) greater odds of in-hospital mortality respectively.DiscussionOur results showed that for all patients presenting to the ED, a rising lactate value is associated with a higher mortality. This pattern was similar regardless of patients’ age, presence of infection or blood pressure at presentation.ConclusionHigher lactate values are associated with higher hospital mortalities and longer ED and hospital lengths of stays. Initial ED lactate is a useful test to risk-stratify critically ill patients presenting to the ED.

Can the quick Sequential Organ Failure Assessment (qSOFA) score, combined with plasma lactate concentration, predict the mortality for patients with infections in the emergency department?

“…We analyzed combination scores containing qSOFA and plasma lactate measurement. As recommended in many studies, plasma lactate level is a significant predictor of mortality in seriously critical patients [12,13]. In contrast to the literature, only plasma lactate level with a cutoff value of 2 mmol/L showed a well predictive performance, but when combined with qSOFA, its efficacy of predictive value in-hospital mortality was lower in our study population.…”

Composite bioscore is superior to routine biomarkers and established scoring systems in predicting mortality in adult critically ill patients with secondary sepsis

“…In our study, lactate levels were statistically significantly higher in nonsurvivors on the 3 rd day and at that time-point demonstrated statistically significant discriminative power regarding outcome; lactate levels higher than cut-off values were good predictors of lethal outcome with AUC of 0.64. These results are in accordance with other similar studies (29,30).…”

Lactate indices as predictors of in-hospital mortality or 90-day survival after admission to an intensive care unit in unselected critically ill patients

“…Similarly, Jansen et al [21] described that prehospital lactate �4.0 mmol/L was highly associated with in-hospital mortality, providing more prognostic information than systolic blood pressure or heart rate in 124 patients. Chebl et al [22] also reported that lactate >4.0 mmol/L in the ED was associated with an increased adjusted OR (>29.0) for in-hospital mortality. Trzeciak et al [23] reported a strong association between initial lactate � 4.0 mmol/L, wherever measured (ED, ICU, or general ward), and acute-phase death (� 3 days) in infectious patients.…”

“…Several studies have indicated that a single initial lactate concentration in prehospital, emergency department (ED), or ICU settings is a strong predictor of outcome [20][21][22][23]. Martín-Rodríguez et al [20] demonstrated an efficient cut-off value of prehospital lactate �4.25 mmol/ L for 30-day mortality in 279 emergency patients.…”