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2014 | 10 | 1 |
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High serum lactate level may predict death within 24 hours

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
Background: Unexpected death within 24 hours of admission is a real challenge for the clinician in the emergency room. How to diagnose these patients and the right approach to prevent sudden death with 24 hours is still an enigma. The aims of our study were to find the independent factors that may affect the clinical outcome in the first 24 hours of admission to the hospital. Methods: We performed a retrospective study defining unexpected death within 24 hours of admission in our Department of Medicine in the last 6 years. We found 43 patients who died within 24 hours of admission, and compared their clinical and biochemical characteristics to 6055 consecutive patients who were admitted in that period of time and did not die within the first 24 hours of admission. The parameters that were used include gender, age, temperature, clinical and laboratory criteria for SIRS, arterial blood lactate, and arterial blood pH. Results: Most of the patients who died within 24 hours had sepsis with SIRS. These patients were older (78.6±14.7 vs. 65.2±20.2 years [p<.0001]), had higher lactate levels (8.0±4.8 vs. 2.1±1.8mmol/L[p<.0001]), and lower pH (7.2±0.2 vs. 7.4±0.1 [p<.0001]). Logistic regression analysis found that lactate was the strongest independent parameter to predict death within 24 hours of admission (OR1.366 [95% CI 1.235-1.512]), followed by old age (OR 1.048 [95% CI 1.048-1.075] and low arterial blood pH (OR 0.007 [CI <0.001-0.147]). When gender was analyzed, pH was not an independent variable in females (only in males). Conclusions: The significant independent variable that predicted death within 24 hours of admission was arterial blood lactate level on admission. Older age was also an independent variable; low pH affected only males, but was a less dominant variable. We suggest use of arterial blood lactate level on admission as a bio-marker in patients with suspected sepsis admitted to the hospital for risk assessment and prediction of death within 24 hours of admission.
Słowa kluczowe
EN
Lactate   SIRS  
Wydawca

Czasopismo
Rocznik
Tom
10
Numer
1
Opis fizyczny
Daty
otrzymano
2015-01-25
zaakceptowano
2015-05-21
online
2015-06-11
Twórcy
autor
  • Department of Medicine, Baruch
    Padeh Poria Hospital, Faculty of Medicine Bar Ilan University, Israel
  • Department of Medicine, Baruch
    Padeh Poria Hospital, Faculty of Medicine Bar Ilan University, Israel
autor
  • Department of Medicine, Baruch
    Padeh Poria Hospital, Faculty of Medicine Bar Ilan University, Israel
autor
  • Department of Health Systems Administration, Max
    Stern Academic College, Emek Yezreel, Lower Galilee 15208 Israel
Bibliografia
  • ---
  • [1] Hilderink MJ, Roest AA, Hermans M, et al. Predictive accuracyand feasibility of risk stratification scores for 28-day mortalityof patients with sepsis in an emergency department. Eur JEmerg Med 2014 Aug 20 [Epub ahead of print]
  • [2] Jones AE, Saak K, Kline JA. Performance of the mortality inemergency department sepsis score for predicting hospitalmortality among patients with severe sepsis and septic shock.Am J Emerg Med 2008;26(6):689-692[Crossref][WoS]
  • [3] Sawicka W, Owczuk R, Wujtewicz MA, Wujtewicz M. Theeffectiveness of the APACHE II, SAPS II, and SOFA prognosticscoring systems in patients with haematological malignanciesin the intensive care unit. Anaesthesiol Intensive Ther2014;46(3):166-170
  • [4] Kruse O, Grunnet N, Barford C. Blood lactate as a predictor forin hospital mortality in patients admitted acutely to hospital: asystemic review. Scandinavian Journal of Trauma, Resuscitationand Emergency Medicine 2011;19:74-86[Crossref]
  • [5] Marty P, Roquilly A, Vallée F, et al. Lactate clearance for deathprediction in severe sepsis or septic shcok patients during thefirst 24 hours in intensive care unit: an observational study.Annals of Intensive Care 2013;3:3-10
  • [6] Scott HF, Donoghue AJ, Gaieski DF, et al. The utility ofearly lactate testing in undifferentiated pediatric systemicinflammatory response syndrome. Academic EmergencyMedicine 2012;19:1276-1280[WoS][Crossref]
  • [7] Khosravani H, Shahpori R, Stelfox HT, et al. Occurrence andadverse effect on outcome of hyperlactemia in the critically ill.Crit Care 2009;13(3):R90[Crossref]
  • [8] Nichol AD, Egi M, Pettila V, et al. Relative hyperlactemia andhospital mortality in critically ill patients: a retrospectivemulti-centre study. Crit Care 2010;14(1):R25[Crossref]
  • [9] Smith I, Kumar P, Molloy S, et al. Base excess and lactate asprognostic indicators for patients admitted to intensive care.Intensive Care Med 2001;27(1):74-83
  • [10] Del Portal DA, Shofer F, Mikkelsen ME, et al. Emergencydepartment lactate is associated with mortality in older adults admitted with and without infections. Acad Emerg Med2010;17(3):260-268[Crossref]
  • [11] Jansen TC, van BJ, Mulder PG, et al. The prognostic valueof blood lactate levels relative to that of vital signs in thepre-hospital setting: a pilot study. Crit Care 2008;12(6):R160[WoS][Crossref]
  • [12] Kaplan LJ, Kellum JA. Initial pH, base deficit, lactate, anion gap,strong ion difference, and strong ion gap predict outcome frommajor vascular injury. Crit Care Med 2004;32(5):1120-1124[Crossref]
  • [13] Pal JD, Victorino GP, Twomey P, et al. Admission serum lactatelevels do not predict mortality in the acutely injured patient. JTrauma 2006;60(3):583-587[Crossref]
  • [14] Vandromme MJ, Griffin RL, Weinberg JA, et al. Lactate is abetter predictor than systolic blood pressure for determiningblood requirement and mortality: could pre-hospital measuresimprove trauma triage? J Am Coll Surg 2010;210(5):861-869
  • [15] Arnold RC, Shapiro NI, Jones AE, et al. Multicenter study ofearly lactate clearance as a determinant of survival in patientswith presumed sepsis. Shock 2009;32(1):35-39[WoS][Crossref]
  • [16] Guyette F, Suffoletto B, Castillo JL, et al. Pre hospital serumlactate as a predictor of outcomes in trauma patients: a retrospectiveobservational study. J Trauma 2011;70(4):782-786[Crossref]
  • [17] Trzeciak S, Dellinger RP, Chansky ME, et al. Serum lactate as apredictor of mortality in patients with infection. Intensive CareMed 2007;33(6):970-977
  • [18] Kaplan LJ, Kellum JA. Comparison of acid base modelsfor prediction of hospital mortality after trauma. Shock2008;29(6):662-666[WoS]
  • [19] Lavery RF, Livingston DH, Tortella BJ, et al. The utility of venouslactate to triage injured patients in the trauma center. J Am CollSurg 2000;190(6):656-664
  • [20] Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearanceis associated with improved outcome in severe sepsis andseptic shock. Crit Care Med 2004;32(8):1637-1642[Crossref]
  • [21] Claridge JA, Crabtree TD, Pelltier SJ, et al. Persistent occulthypoperfusion is associated with a significant increase ininfection rate and mortality in major trauma patients. J Trauma2000;48(1):8-14[Crossref]
  • [22] Jansen TC, van BJ, Mulder PG, et al. Prognostic value of bloodlactate levels: does the clinical diagnosis at admission matter?J Trauma 2009;66(2):377-385[WoS][Crossref]
  • [23] Jansen TC, van BJ, Schoonderbeek FJ, et al. Early lactateguided therapy in intensive care unit patients: a multicenter,open-label, randomized controlled trial. Am J Respire Crit CareMed 2010;182(6):752-761[Crossref]
  • [24] Gallagher EJ, Rodriguez K, Touger M. Agreement betweenperipheral venous and arterial lactate levels. Annals EmergMed 1997;29(4):479-483[Crossref]
  • [25] Younger JG, Falk JL, Rothrock SG. Relationship betweenarterial and peripheral venous lactate levels. Acad Emerg Med1996;3(7):730-734[Crossref]
Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_1515_med-2015-0045
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