Evaluation of the Prognostic Value of Lactate and Acid-base Status in Patients Presenting to the Emergency Department
Abstract IntroductionPoint-of-care metabolic screens are frequently used in the assessment of critical illness. Lactate levels predict mortality in a wide range of patients presenting to the Emergency Department but the effect of co-existing acidosis is unknown. We investigated the effect that acidosis has on in-hospital mortality for patients with hyperlactataemia. Methods This is a retrospective cohort study. The inclusion criteria were patients over 17 years of age who received a metabolic panel on arrival to the resuscitation area of the Emergency Department. The primary outcome was in-hospital mortality. The groups were normal lactate (0.0-2.0 mmol/L), intermediate lactate (2.1-4.0 mmol/L) and high lactate (>4.0 mmol/L), with and without acidosis. Odds ratios (OR) were calculated to assess the differences in mortality rates between groups stratified by lactate and acid-base status.Results 4107 metabolic panels were collected and 3238 were assessed. 510 (15.8%) & 784 (24.2%) patients had a normal lactate and acidosis or no acidosis respectively. 587 (18.1%) & 842 (26.0%) patients had intermediate lactate and acidosis or no acidosis respectively. 388 (12.0%) & 127 (3.9%) patients had high lactate and acidosis or no acidosis respectively. The overall mortality was 5%. In normal lactate group mortality was 4.3% and 0.6%, intermediate lactate mortality was 5.6% and 2.6%, and high lactate group mortality was 19.3% and 3.9%, with and without acidosis respectively. Combining base excess < -6 and lactate >4 mmol/L had a sensitivity of 39%, specificity of 96%, positive predictive value of 32% and a negative predictive value of 98% for in-hospital mortality, OR 14.0 (95% CI 9.77 – 20.11). Conclusion In an undifferentiated cohort of Emergency Department patients presenting to the resuscitation area lactaemia associated with acidosis is a more accurate predictor of in-hospital mortality than hyperlactataemia..
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Preprint| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
ResearchSquare.com - (2021) vom: 17. März Zur Gesamtaufnahme - year:2021 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
D'Abrantes, Ramiro [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| doi: |
10.21203/rs.3.rs-92196/v1 |
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| PPN (Katalog-ID): |
XRA034720812 |
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| 520 | |a Abstract IntroductionPoint-of-care metabolic screens are frequently used in the assessment of critical illness. Lactate levels predict mortality in a wide range of patients presenting to the Emergency Department but the effect of co-existing acidosis is unknown. We investigated the effect that acidosis has on in-hospital mortality for patients with hyperlactataemia. Methods This is a retrospective cohort study. The inclusion criteria were patients over 17 years of age who received a metabolic panel on arrival to the resuscitation area of the Emergency Department. The primary outcome was in-hospital mortality. The groups were normal lactate (0.0-2.0 mmol/L), intermediate lactate (2.1-4.0 mmol/L) and high lactate (>4.0 mmol/L), with and without acidosis. Odds ratios (OR) were calculated to assess the differences in mortality rates between groups stratified by lactate and acid-base status.Results 4107 metabolic panels were collected and 3238 were assessed. 510 (15.8%) & 784 (24.2%) patients had a normal lactate and acidosis or no acidosis respectively. 587 (18.1%) & 842 (26.0%) patients had intermediate lactate and acidosis or no acidosis respectively. 388 (12.0%) & 127 (3.9%) patients had high lactate and acidosis or no acidosis respectively. The overall mortality was 5%. In normal lactate group mortality was 4.3% and 0.6%, intermediate lactate mortality was 5.6% and 2.6%, and high lactate group mortality was 19.3% and 3.9%, with and without acidosis respectively. Combining base excess < -6 and lactate >4 mmol/L had a sensitivity of 39%, specificity of 96%, positive predictive value of 32% and a negative predictive value of 98% for in-hospital mortality, OR 14.0 (95% CI 9.77 – 20.11). Conclusion In an undifferentiated cohort of Emergency Department patients presenting to the resuscitation area lactaemia associated with acidosis is a more accurate predictor of in-hospital mortality than hyperlactataemia. | ||
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