title: Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda.
abstract: BACKGROUND
  Prediction of mortality may improve management and outcomes of patients with sepsis in resource-limited settings. Therefore, we evaluated the ability of a hand-held portable whole-blood lactate (PWBL) analyzer to predict mortality of patients who are admitted to the hospital with severe sepsis.
  
  
  METHODS
  A prospective observational study enrolled 253 patients at a national referral hospital in Uganda. Inclusion criteria required (1) >or=2 systemic inflammatory response syndrome criteria or thermodysregulation, (2) hypotension, and (3) suspected infection. A subset of 72 patients had PWBL and standard laboratory serum lactate measured. The primary measured outcome was in-hospital mortality.
  
  
  RESULTS
  Fifty-nine (81.9%) of 72 evaluated patients were infected with human immunodeficiency virus type 1. The in-hospital mortality rate was 25.7% (18 of 70), and the in- and outpatient mortality at 30 days was 41.6% (30 of 72). PWBL was positively associated with in-hospital but not outpatient mortality (P=.001). The receiver operating characteristic area under the curve for PWBL was 0.81 (P=.081). The optimal PWBL concentration for predicting in-hospital mortality (sensitivity, 88.3%; specificity, 71.2%) was >or=4.0 mmol/L. Patients with a PWBL concentration >or=4.0 mmol/L died while in the hospital substantially more often (50.0%) than did those with a PWBL concentration <4.0 mmol/L (7.5%) (odds ratio, 12.3; 95% confidence interval, 3.5-48.9; [P=.001). Standard laboratory serum lactate results were inconsistent and less predictive of mortality than were those of PWBL in a multiple logistic regression model.
  
  
  CONCLUSIONS
  A PWBL concentration >or=4.0 mmol/L predicts with 81% accuracy a 7-fold higher mortality of patients with sepsis than does a PWBL concentration <4.0 mmol/L. PWBL testing would be useful in places where clinical decisions are limited by lack of laboratory infrastructure and poor reliability.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, VA 22908, USA. ccm5u@virginia.edu
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Moore
authors.forename: Shevin T
authors.initials: ST
authors.lastname: Jacob
authors.forename: Relana
authors.initials: R
authors.lastname: Pinkerton
authors.forename: David B
authors.initials: DB
authors.lastname: Meya
authors.forename: Harriet
authors.initials: H
authors.lastname: Mayanja-Kizza
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: W Michael
authors.initials: WM
authors.lastname: Scheld
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000382:microbiology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000821:virology; D014454:Uganda
chemical_list: D019344:Lactic Acid