Francisco Martín-Rodríguez1,2, Raúl López-Izquierdo1,3, Elena Medina-Lozano1, Guillermo Ortega Rabbione4,5, Carlos Del Pozo Vegas6, Virginia Carbajosa Rodríguez3, Miguel Ángel Castro Villamor1, Irene Sánchez-Soberon2, Ancor Sanz-García4. 1. Advanced Clinical Simulation Center. School of Medicine, Valladolid University. Avda. Ramón y Cajal, nº 7, 47005, Valladolid, Spain. 2. Emergency Medical Services-SACYL. Paseo Hospital Militar, nº 24, 47007, Valladolid, Spain. 3. Emergency Department. Hospital, Universitario Rio Hortega. C/ Dulzaina, 2, 47012, Valladolid, Spain. 4. Data Analysis Unit, Health Research Institute, Hospital de la Princesa (IIS-IP), Calle de Diego de León, nº 62, 28006, Madrid, Spain. 5. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290 (C1425FQB) CABA, Buenos Aires, Argentina. 6. Emergency Department. Hospital, Clínico Universitario. Avda. Ramón y Cajal, nº 3, 47003, Valladolid, Spain.
Abstract
BACKGROUND: Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable, and easy to perform warning biomarkers could help in such decision-making processes. The present study aims at characterizing the validity of point-of-care lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance. MATERIALS AND METHODS: Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC). RESULTS: A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors, and 5.7 mmol/L (4.4-7.6) in non-survivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cut off point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology. CONCLUSIONS: Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification ofrisky patients , leading to a better care of such patients. This article is protected by copyright. All rights reserved.
BACKGROUND: Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable, and easy to perform warning biomarkers could help in such decision-making processes. The present study aims at characterizing the validity of point-of-care lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance. MATERIALS AND METHODS: Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC). RESULTS: A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors, and 5.7 mmol/L (4.4-7.6) in non-survivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cut off point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology. CONCLUSIONS: Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification ofrisky patients , leading to a better care of such patients. This article is protected by copyright. All rights reserved.
Authors: Francisco Martín-Rodríguez; Raúl López-Izquierdo; Ancor Sanz-García; Carlos Del Pozo Vegas; Miguel Ángel Castro Villamor; Agustín Mayo-Iscar; José L Martín-Conty; Guillermo José Ortega Journal: J Med Syst Date: 2022-05-21 Impact factor: 4.920