STUDY OBJECTIVE: We determine whether C-reactive protein (CRP) adds prognostic value to serum lactate levels when assessing mortality risk in emergency department (ED) patients admitted for a suspected infection. METHODS: This was an observational cohort of unique adult patients (≥ 21 years of age) who had lactate and CRP testing in the ED and were admitted for a suspected infection during a 1-year period. All data were collected through retrospective chart review. The study site is an urban teaching hospital with an approximate annual census of 95,000 patients. The endpoint was 28-day inpatient mortality. RESULTS: One thousand one hundred forty-three patients had lactate and CRP testing in the ED, an admitting diagnosis of infection, and complete records. Twenty-eight-day inpatient mortality for patients with both a lactate level greater than or equal to 4.0 mmol/L and CRP level greater than 10.0 mg/dL was 44.0% (95% confidence interval [CI] 32.5% to 55.5%), for lactate greater than or equal to 4.0 mmol/L and CRP less than or equal to 10.0 mg/dL, it was 9.7% (95% CI 2.7% to 16.7%), and for lactate level less than 4.0 mmol/L, it was 9.1% (95% CI 7.3% to 10.9%). In a logistic regression model that included patient demographics and Charlson score, as well as 4 separate dichotomous variables that were positive only in subjects with (1) serum lactate greater than or equal to 4.0 mmol/L and CRP level greater than 10.0 mg/dL, (2) lactate level greater than or equal to 4.0 mmol/L and CRP level less than or equal to 10.0 mg/dL, (3) lactate level less than 4.0 mmol/L and CRP level greater than 10.0 mg/dL, and (4) lactate level less than 4.0 mmol/L and CRP level less than or equal to 10.0 mg/dL (as reference), patients with both a lactate level greater than or equal to 4.0 mmol/L and CRP greater than 10 mg/dL had an increased risk of 28-day inpatient mortality (odds ratio 12.3; 95% CI 6.8 to 22.3). CONCLUSION: In this cohort, patients with both an increased CRP level and hyperlactatemia had a higher mortality rate than patients with abnormalities of either laboratory test in isolation.
STUDY OBJECTIVE: We determine whether C-reactive protein (CRP) adds prognostic value to serum lactate levels when assessing mortality risk in emergency department (ED) patients admitted for a suspected infection. METHODS: This was an observational cohort of unique adult patients (≥ 21 years of age) who had lactate and CRP testing in the ED and were admitted for a suspected infection during a 1-year period. All data were collected through retrospective chart review. The study site is an urban teaching hospital with an approximate annual census of 95,000 patients. The endpoint was 28-day inpatient mortality. RESULTS: One thousand one hundred forty-three patients had lactate and CRP testing in the ED, an admitting diagnosis of infection, and complete records. Twenty-eight-day inpatient mortality for patients with both a lactate level greater than or equal to 4.0 mmol/L and CRP level greater than 10.0 mg/dL was 44.0% (95% confidence interval [CI] 32.5% to 55.5%), for lactate greater than or equal to 4.0 mmol/L and CRP less than or equal to 10.0 mg/dL, it was 9.7% (95% CI 2.7% to 16.7%), and for lactate level less than 4.0 mmol/L, it was 9.1% (95% CI 7.3% to 10.9%). In a logistic regression model that included patient demographics and Charlson score, as well as 4 separate dichotomous variables that were positive only in subjects with (1) serum lactate greater than or equal to 4.0 mmol/L and CRP level greater than 10.0 mg/dL, (2) lactate level greater than or equal to 4.0 mmol/L and CRP level less than or equal to 10.0 mg/dL, (3) lactate level less than 4.0 mmol/L and CRP level greater than 10.0 mg/dL, and (4) lactate level less than 4.0 mmol/L and CRP level less than or equal to 10.0 mg/dL (as reference), patients with both a lactate level greater than or equal to 4.0 mmol/L and CRP greater than 10 mg/dL had an increased risk of 28-day inpatient mortality (odds ratio 12.3; 95% CI 6.8 to 22.3). CONCLUSION: In this cohort, patients with both an increased CRP level and hyperlactatemia had a higher mortality rate than patients with abnormalities of either laboratory test in isolation.
Authors: Rémi Coudroy; Angéline Jamet; Jean-Pierre Frat; Anne Veinstein; Delphine Chatellier; Véronique Goudet; Severin Cabasson; Arnaud W Thille; René Robert Journal: Intensive Care Med Date: 2014-12-17 Impact factor: 17.440
Authors: Jeffrey P Green; Tony Berger; Nidhi Garg; Alison Suarez; Yolanda Hagar; Michael S Radeos; Edward A Panacek Journal: Am J Emerg Med Date: 2012-03-16 Impact factor: 2.469
Authors: Raymond J Langley; Ephraim L Tsalik; Jennifer C van Velkinburgh; Seth W Glickman; Brandon J Rice; Chunping Wang; Bo Chen; Lawrence Carin; Arturo Suarez; Robert P Mohney; Debra H Freeman; Mu Wang; Jinsam You; Jacob Wulff; J Will Thompson; M Arthur Moseley; Stephanie Reisinger; Brian T Edmonds; Brian Grinnell; David R Nelson; Darrell L Dinwiddie; Neil A Miller; Carol J Saunders; Sarah S Soden; Angela J Rogers; Lee Gazourian; Laura E Fredenburgh; Anthony F Massaro; Rebecca M Baron; Augustine M K Choi; G Ralph Corey; Geoffrey S Ginsburg; Charles B Cairns; Ronny M Otero; Vance G Fowler; Emanuel P Rivers; Christopher W Woods; Stephen F Kingsmore Journal: Sci Transl Med Date: 2013-07-24 Impact factor: 17.956
Authors: Eren Gultepe; Jeffrey P Green; Hien Nguyen; Jason Adams; Timothy Albertson; Ilias Tagkopoulos Journal: J Am Med Inform Assoc Date: 2013-08-19 Impact factor: 4.497