scholarly journals The utility of peripheral venous lactate in emergency department patients with normal and higher lactate levels: A prospective observational study

2020 ◽  
Vol 19 (3) ◽  
pp. 125-130
Author(s):  
Arne Jon Van Tienhoven ◽  
◽  
Cornelis AJ Van Beers ◽  
Carl EH Siegert ◽  
Prabath WB Nanayakkara ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Mean Difference ◽  
Limits Of Agreement ◽  
Arterial Lactate ◽  
Arterial Sampling ◽  
Emergency Department Patients ◽  
Lactate Levels

Objective: to assess the utility of peripheral venous lactate (PVL) in Emergency Department patients. Methods: arteriovenous agreement was assessed in three subgroups: PVL <2 mmol/l, PVL ≥ 2 mmol/l to < 4 mmol/l and PVL ≥ 4 mmol/l. The predictive value of PVL to predict arterial lactate (AL) ≥2 mmol/l was assessed at different cut-off values. Results: 74 samples were analysed. The venous-arterial mean difference and 95% limits of agreement for the subgroups were 0.25 mmol/l (-0.18 to 0.68), 0.37 mmol/l (-0.57 to 1.32) and -0.89 mmol/l (-3.75 to 1.97). PVL ≥2 mmol/l predicts AL ≥2 mmol/l with 100% sensitivity. Conclusion: PVL <2 mmol/l rules out arterial hyperlactatemia. As agreement declines in higher levels, arterial sampling should be considered.

Evaluation of the Prognostic Value of Lactate and Acid-base Status in Patients Presenting to the Emergency Department

2020 ◽  
Author(s):  
Ramiro D'Abrantes ◽  
Laura DUNN ◽  
Tim MCMILLAN ◽  
Ben CORNWELL ◽  
Ben BLOOM ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Point Of Care ◽  
Acid Base ◽  
Wide Range ◽  
Acid Base Status ◽  
Emergency Department Patients ◽  
Lactate Levels ◽  
High Lactate

Abstract IntroductionPoint-of-care metabolic screens are frequently used in the assessment of critical illness. Lactate levels predict mortality in a wide range of patients presenting to the Emergency Department but the effect of co-existing acidosis is unknown. We investigated the effect that acidosis has on in-hospital mortality for patients with hyperlactataemia. Methods This is a retrospective cohort study. The inclusion criteria were patients over 17 years of age who received a metabolic panel on arrival to the resuscitation area of the Emergency Department. The primary outcome was in-hospital mortality. The groups were normal lactate (0.0-2.0 mmol/L), intermediate lactate (2.1-4.0 mmol/L) and high lactate (>4.0 mmol/L), with and without acidosis. Odds ratios (OR) were calculated to assess the differences in mortality rates between groups stratified by lactate and acid-base status.Results 4107 metabolic panels were collected and 3238 were assessed. 510 (15.8%) & 784 (24.2%) patients had a normal lactate and acidosis or no acidosis respectively. 587 (18.1%) & 842 (26.0%) patients had intermediate lactate and acidosis or no acidosis respectively. 388 (12.0%) & 127 (3.9%) patients had high lactate and acidosis or no acidosis respectively. The overall mortality was 5%. In normal lactate group mortality was 4.3% and 0.6%, intermediate lactate mortality was 5.6% and 2.6%, and high lactate group mortality was 19.3% and 3.9%, with and without acidosis respectively. Combining base excess < -6 and lactate >4 mmol/L had a sensitivity of 39%, specificity of 96%, positive predictive value of 32% and a negative predictive value of 98% for in-hospital mortality, OR 14.0 (95% CI 9.77 – 20.11). Conclusion In an undifferentiated cohort of Emergency Department patients presenting to the resuscitation area lactaemia associated with acidosis is a more accurate predictor of in-hospital mortality than hyperlactataemia.

Can Peripheral Venous Lactate Levels Substitute for Arterial Lactate Levels in The Emergency Department? An Observational Study

2020 ◽  
Author(s):  
Yasufumi Oi ◽  
Kosuke Mori ◽  
Hidehiro Yamagata ◽  
Ayako Nogaki ◽  
Tomoaki Takeda ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Altman Analysis ◽  
Arterial Lactate ◽  
Cutoff Value ◽  
Bland Altman Analysis ◽  
Lactate Levels

Abstract Background: Arterial lactate (AL) level is an important parameter used to predict patients’ prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. However, if the AL range can be predicted from PVL, PVL may be an alternative method of predicting patient prognosis, and the risk of arterial puncture complications with AL may be reduced. This could become a safe and rapid test method.Methods: This was a retrospective observational study of 143 cases in which blood gas analysis was performed on both arterial blood and venous blood in an emergency department. Spearman's rank correlation coefficient (r) and Bland–Altman analysis were performed. Sensitivity, specificity, and the area under the curve (AUC) were calculated for PVL to predict AL < 2 mmol/L or < 4 mmol/L.Results: The median [interquartile range] AL and PVL were 1.82 [1.25–2.58] vs 2.09 [1.57–3.29], respectively, r was 0.799 (p<0.0001), and a strong correlation was observed; however, Bland–Altman analysis showed disagreement. When AL < 2 mmol/L was used as the outcome, AUC was 0.974, the PVL cutoff value was 2.55 mmol/L, sensitivity was 87.9%, and specificity was 94.1%. If PVL < 2 mmol/L was the outcome, the sensitivity for AL < 2 mmol/L was 100%, and for PVL levels ≥ 3 mmol/L, the specificity was 100%. When AL < 4 mmol/L was used as the outcome, AUC was 0.970, the PVL cutoff value was 3.4 mmol/L, sensitivity was 100%, and specificity was 84.5%. When PVL < 3.5 mmol/L was the outcome, the sensitivity for AL < 4 mmol/L was 100%, and for PVL levels ≥ 4 mmol/L, the specificity was 93.8%.Conclusions: This study revealed that PVL and AL levels in the same critically ill patients do not perfectly agree with each other but are strongly correlated. Furthermore, the high accuracy for predicting AL ranges from PVL levels explains why PVL levels could be used as a substitute for AL level ranges.

Sign in / Sign up

Export Citation Format

Share Document