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Observational Study
. 2020 Aug 17;28(1):82.
doi: 10.1186/s13049-020-00777-y.

Elevated admission lactate levels in the emergency department are associated with increased 30-day mortality in non-trauma critically ill patients

Michael Bernhard  1 , Stephanie Döll  2 , Andre Kramer  3 , Lorenz Weidhase  4 , Thomas Hartwig  5 , Sirak Petros  4 , André Gries  5
Affiliations
Observational Study

Elevated admission lactate levels in the emergency department are associated with increased 30-day mortality in non-trauma critically ill patients

Michael Bernhard et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Elevated blood lactate levels were reported as useful predictors of clinical outcome and mortality in critically ill patients. To identify higher-risk patients, this investigation evaluated the relationship between patient mortality and admission lactate levels during the management of non-trauma critically ill patients in the emergency department (ED).

Methods: In this prospective, single centre observational study in a German university ED, all adult patients who were admitted to the ED resuscitation room were evaluated between September 1, 2014 and August 31, 2015. Blood samples for blood gas analysis, including lactate levels, were obtained immediately at admission. Study endpoint was 30-day mortality.

Results: During the study period, 532 patients were admitted to the resuscitation room of the ED. The data of 523 patients (98.3%) were available. The overall 30-day mortality was 34.2%. Patients presenting to the resuscitation room with admission lactate levels < 2.0 mmol/l had a 30-day mortality of 22.7%, while admission lactate levels above 8.0 mmol/l were associated with higher mortality (8.0-9.9 mmol/l: OR: 2.83, 95%CI: 1.13-7.11, p = 0.03, and ≥ 10 mmol/l: OR: 7.56, 95%CI: 4.18-13.77, p < 0.001).

Conclusion: High lactate levels at admission are associated with an increased 24-h and 30-day mortality. These measurements may be used not only to predict mortality, but to help identify patients at risk for becoming critically ill. The breakpoint for mortality may be an ALL ≥8.0 mmol/l.

Keywords: Admission lactate; Emergency department; Mortality; Non-trauma critically ill; Resuscitation room.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
24-h mortality and 30-day mortality compared to admission lactate level category
Fig. 2
Fig. 2
Kaplan-Meier survival curve for admission lactate level categories
Fig. 3
Fig. 3
30-day mortality in patients with admission lactate levels (ALL) < 4.0 and ≥ 4.0 mmol/l divided into non-hypotensive and hypotensive subgroups: a) including patients under ongoing cardiopulmonary resuscitation at hospital admission, b) without patients under ongoing cardiopulmonary resuscitation at hospital admission
See this image and copyright information in PMC

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