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Peripheral venous lactate at admission is associated with in‐hospital mortality, a prospective cohort study
Author(s) -
BARFOD C.,
LUNDSTRØM L. H.,
LAURITZEN M. M. P.,
DANKER J. K.,
SÖLÉTORMOS G.,
FORBERG J. L.,
BERLAC P. A.,
LIPPERT F. K.,
ANTONSEN K.,
LANGE K. H. W.
Publication year - 2015
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12503
Subject(s) - medicine , odds ratio , prospective cohort study , confidence interval , triage , cohort , cohort study , mortality rate , venous blood , emergency medicine
Background The prognostic value of blood lactate as a predictor of adverse outcome in the acutely ill patient is unclear. The aim of this study was to investigate if a peripheral venous lactate measurement, taken at admission, is associated with in‐hospital mortality in acutely ill patients with all diagnosis. Furthermore, we wanted to investigate if the test improves a triage model in terms of predicting in‐hospital mortality. Methods We retrieved a cohort of 2272 adult patients from a prospectively gathered acute admission database. We performed regression analysis to evaluate the association between the relevant covariates and the outcome measure: in‐hospital mortality. Results Lactate as a continuous variable was a risk for in‐hospital mortality with an odds ratio ( OR ) of 1.40 [95% confidence interval ( CI ) 1.25–1.57, P < 0.0001]. OR for in‐hospital mortality increased with increasing lactate levels from 2.97 (95% CI 1.55–5.72, P < 0.001) for lactate between 2 mmol/l and 4 mmol/l, to 7.77 (95% CI 3.23–18.66, P < 0.0001) for lactate > 4 mmol/l. If the condition was non‐compensated (i.e. pH < 7.35), OR for in‐hospital mortality increased to 19.99 (7.26–55.06, P < 0.0001). Patient with a blood lactate at 4 mmol/l or more had a risk of in‐hospital mortality equivalent to the patients in the most urgent triage category. Conclusion We found elevated admission peripheral venous lactate to be independently associated with in‐hospital mortality in the acutely ill patient admitted to the emergency department. Patients with a lactate > 4 mmol/l at hospital admission should be considered triaged to the most urgent triage category.