Sharukh Lokhandwala1, Lars W Andersen2, Sunil Nair3, Parth Patel4, Michael N Cocchi5, Michael W Donnino6. 1. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA; Massachussetts Institute of Technology, Cambridge, MA; Department of Medicine, Division of Pulmonary and Critical Care, University of Washington, Seattle, WA. Electronic address: slokhand@uw.edu. 2. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark. Electronic address: lwanders@bidmc.harvard.edu. 3. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: ssnair@bidmc.harvard.edu. 4. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: pvpatel@bidmc.harvard.edu. 5. Harvard Medical School, Boston, MA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: mcocchi@bidmc.harvard.edu. 6. Harvard Medical School, Boston, MA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: mdonnino@bidmc.harvard.edu.
Abstract
PURPOSE: Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4mmol/L, we compared mortality prediction between a subsequent lactate ≥4mmol/L to a <10% and <20% decrease between initial and subsequent lactate values. MATERIALS AND METHODS: We performed a single-center retrospective study of patients presenting to the emergency department with an initial lactate ≥4mmol/L and suspected infection. Patients were stratified by lactate reduction using 3 previously identified definitions (subsequent lactate ≥4mmol/L, and <10% and <20% relative decrease in lactate) and compared using multivariable logistic regression. Sensitivity and specificity were compared using McNemar test. RESULTS: A subsequent lactate ≥4mmol/L and a lactate reduction <20% were associated with increased in-hospital mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.24-8.16; P=.02 and OR, 3.11; 95% CI, 1.39-6.96; P=.006, respectively), whereas a lactate reduction <10% was not (OR, 1.13; 95% CI, 0.94-1.34; P=.11). A subsequent lactate ≥4mmol/L and a lactate reduction <20% were more sensitive than a lactate reduction <10% (72% vs 41%, P=.002 and 62% vs 41%, P=.008, respectively) but less specific (57% vs 76%, P<.001 and 67% vs 76%, P=.002, respectively). CONCLUSIONS: A subsequent lactate ≥4mmol/L and lactate reduction <20% were associated with increased in-hospital mortality, whereas a lactate reduction <10% was not. Sensitivity and specificity are different between these parameters.
PURPOSE:Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4mmol/L, we compared mortality prediction between a subsequent lactate ≥4mmol/L to a <10% and <20% decrease between initial and subsequent lactate values. MATERIALS AND METHODS: We performed a single-center retrospective study of patients presenting to the emergency department with an initial lactate ≥4mmol/L and suspected infection. Patients were stratified by lactate reduction using 3 previously identified definitions (subsequent lactate ≥4mmol/L, and <10% and <20% relative decrease in lactate) and compared using multivariable logistic regression. Sensitivity and specificity were compared using McNemar test. RESULTS: A subsequent lactate ≥4mmol/L and a lactate reduction <20% were associated with increased in-hospital mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.24-8.16; P=.02 and OR, 3.11; 95% CI, 1.39-6.96; P=.006, respectively), whereas a lactate reduction <10% was not (OR, 1.13; 95% CI, 0.94-1.34; P=.11). A subsequent lactate ≥4mmol/L and a lactate reduction <20% were more sensitive than a lactate reduction <10% (72% vs 41%, P=.002 and 62% vs 41%, P=.008, respectively) but less specific (57% vs 76%, P<.001 and 67% vs 76%, P=.002, respectively). CONCLUSIONS: A subsequent lactate ≥4mmol/L and lactate reduction <20% were associated with increased in-hospital mortality, whereas a lactate reduction <10% was not. Sensitivity and specificity are different between these parameters.
Authors: Catarina Mendes Silva; João Pedro Baptista; Paulo Mergulhão; Filipe Froes; João Gonçalves-Pereira; José Manuel Pereira; Claudia Camila Dias; José Artur Paiva Journal: Rev Bras Ter Intensiva Date: 2022 Jan-Mar
Authors: Amanda L Webb; Nicholas Kramer; Javier Rosario; Larissa Dub; David Lebowitz; Kendra Amico; Leoh Leon; Tej G Stead; Ariel Vera; Latha Ganti Journal: Cureus Date: 2020-04-27