Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 22:7:561.
doi: 10.3389/fmed.2020.00561. eCollection 2020.

Relative Hyperlactatemia in the Emergency Department

Ralphe Bou Chebl  1 , Sarah Jamali  1 , Nancy Mikati  1 , Reem Al Assaad  1 , Karim Abdel Daem  1 , Nadim Kattouf  1 , Rawan Safa  1 , Maha Makki  2 , Hani Tamim  2 , Gilbert Abou Dagher  1
Affiliations

Relative Hyperlactatemia in the Emergency Department

Ralphe Bou Chebl et al. Front Med (Lausanne). .

Abstract

Objective: The clinical interpretation of lactate ≤ 2.00 mmol/L in emergency department (ED) patients is not well-characterized. This study aims to determine the optimal cutoff value for lactate within the reference range that predicts in-hospital mortality among ED patients. Methods: This was a retrospective study of adult patients presenting to a tertiary ED with an initial serum lactate level of <2.00 mmol/L. The primary outcome was in-hospital mortality. Youden's index was utilized to determine the optimal threshold that predicts mortality. Patients above the threshold were labeled as having relative hyperlactatemia. Results: During the study period, 1,638 patients were included. The mean age was 66.9 ± 18.6 years, 47.1% of the population were female, and the most prevalent comorbidity was hypertension (56.7%). The mean lactate level at presentation was 1.5 ± 0.3 mmol/L. In-hospital mortality was 3.8% in the overall population, and 16.2% were admitted to the ICU. A lactate level of 1.33 mmol/L was found to be the optimal cutoff that best discriminates between survivors and non-survivors. Relative hyperlactatemia was an independent predictor of in-hospital mortality (OR 1.78 C1.18-4.03; p = 0.02). Finally, relative hyperlactatemia was associated with increased mortality in patients without hypertension (4.7 vs. 1.1%; p = 0.008), as well as patients without diabetes or COPD. Conclusion: The optimal cutoff of initial serum lactate that discriminates between survivors and non-survivors in the ED is 1.33 mmol/L. Relative hyperlactatemia is associated with increased mortality in emergency department patients, and this interaction seems to be more important in healthy patients.

Keywords: emergency & critical care; lactate; morbidity; mortality; sepsis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of patient selection.
Figure 2
Figure 2
Receiver operating curve and area under the curve. The optimal cutoff that differentiates between survivors and non-survivors was found to be 1.33, and the area under the curve for that value was 0.545 (95% CI 0.477–0.614).
See this image and copyright information in PMC

References

    1. Mizock BA. Lactic acidosis. Disease-a-Month. (1989) 35:233–300. 10.1016/0011-5029(89)90021-7 - DOI - PubMed
    1. Kreisberg RA. Lactate homeostasis and lactic acidosis. Ann Internal Med. (1980) 92:227–37. 10.7326/0003-4819-92-2-227 - DOI - PubMed
    1. Aduen J, Bernstein WK, Khastgir T, Miller J, Kerzner R, Bhatiani A, et al. . The use and clinical importance of a substrate-specific electrode for rapid determination of blood lactate concentrations. JAMA. (1994) 272:1678–85. 10.1001/jama.1994.03520210062033 - DOI - PubMed
    1. Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg. (1996) 171:221–6. 10.1016/S0002-9610(97)89552-9 - DOI - PubMed
    1. Bellomo R. Marik PE. Lactate clearance as a target of therapy in sepsis: a flawed paradigm. OA Crit Care. (2013) 1:3 10.13172/2052-9309-1-1-431 - DOI

LinkOut - more resources