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. 2025 Jun 1;32(3):171-179.
doi: 10.1097/MEJ.0000000000001207. Epub 2024 Dec 11.

Association between lactate determined at emergency department arrival and the probability of inhospital mortality and intensive care admission in elderly patients

Aitor Alquézar-Arbé  1 , Sergio Pérez-Baena  1 , Cesáreo Fernández  2 , Sira Aguiló  3 , Guillermo Burillo  4 , Javier Jacob  5 , Pere Llorens  6 , Jesús Santianes Patiño  7 , Paula Queizán García  8 , Diana Rosendo Mesino  9 , Osvaldo Jorge Troiano Ungerer  10 , Aarati Vaswani-Bulchand  11 , Montserrat Rodríguez-Cabrera  12 , Mabel Coromoto Suárez Pineda  13 , Patricia Gantes Nieto  14 , Francesc Xavier Alemany González  3 , Ana Puche Alcaraz  15 , María Bóveda García  16 , Mónica Veguillas Benito  17 , Francisco Chamorro  5 , Coral Suero Méndez  18 , Eva Fragero Blesa  19 , Rodrigo Javier Gil Hernández  20 , Paula Pedraza Ramírez  21 , Juan González Del Castillo  2 , Òscar Miró  3 ; (on behalf of the SIESTA Network)
Affiliations

Association between lactate determined at emergency department arrival and the probability of inhospital mortality and intensive care admission in elderly patients

Aitor Alquézar-Arbé et al. Eur J Emerg Med. .

Abstract

Background and importance: Elderly patients often have atypical clinical presentations. Lactate measurement on arrival at the Emergency Department (ED) could be useful to identify elderly patients with a bad prognosis.

Objective: The study aimed to investigate the relationship between serum lactate determined at ED arrival and the probability of inhospital mortality and intensive care (ICU) admission in elderly patients.

Design: Retrospective multipurpose registry. Secondary analysis of the EDEN cohort (Elderly Department and Elder Needs).

Settings and participants: All patients ≥65 years attending 52 Spanish EDs during 2 week and in whom serum lactate was determined at ED arrival.

Outcome measures and analysis: The relationship between serum lactate values and the risk of inhospital all-cause death and transfer from the ED to the ICU was assessed by unadjusted and adjusted logistic regression assuming linearity and restricted cubic spline models assuming nonlinearity.

Results: The cohort included 25 557 patients. The 3024 patients in whom lactate was measured were analyzed. The median age was 81 years (74-87), 1506 (27.2%) were women, 591 (19.5%) had serious comorbidities, 475 (15.7%) severe dependency, and 648 (21.4%) dementia. Death occurred during hospitalization in 217 patients (7.2%) and 53 patients (1.75%) were admitted to the ICU. Serum lactate values were nonlinear related to inhospital mortality and ICU admission. Serum lactate >3.1 mmol/L [odds ratio (OR): 1.60, 95% confidence interval (CI): 1.02-2.50] for inhospital mortality and 3.2 mmol/L (OR: 2.83, 95% CI: 1.03-6.79) for ICU admission were associated with significantly increased ORs in the adjusted models.

Conclusion: Serum lactate measured at ED arrival has a significant and exponential relationship with inhospital mortality and ICU admission in elderly patients.

Keywords: elderly; emergency department; lactate.

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