title: Arterial lactate improves the prognostic performance of severity score systems in septic patients in the ED.
abstract: OBJECTIVE
  To evaluate the prognostic performance of lactate in septic patients in the emergency department (ED) and investigate how to add lactate to the traditional score systems.
  
  
  METHODS
  This was a single-centered, prospective, observational cohort study conducted in ED of Beijing Chao-Yang Hospital. The study enrolled adult septic patients admitted to the ED. Arterial lactate was measured in every patient. Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), and Mortality in Emergency Department Sepsis (MEDS) scores were calculated on ED arrival. The primary outcome was 28-day mortality.
  
  
  RESULTS
  The average levels of lactate, MEDS, APACHE II, and SOFA were much higher in nonsurvivors than in survivors (P < .001), and they were the independent predictors of 28-day mortality. Area under receiver operating characteristic (AUC) curves of MEDS, APACHE II, SOFA, and lactate were 0.74, 0.74, 0.75, and 0.79, respectively. The AUCs of combination lactate and MEDS, APACHE II, and SOFA were 0.81, 0.81, and 0.82, respectively and were much higher than that of score systems alone (P < .05). The AUCs of modified MEDS, APACHE II, and SOFA were 0.80, 0.80, and 0.81, respectively. The prognostic value of the modified score systems was superior to the original score systems and similar to the combination of the lactate and original score systems.
  
  
  CONCLUSIONS
  Lactate is a prognostic predictor in septic patients in the ED, and it may improve the performance of APACHE II, SOFA, and MEDS scores in predicting mortality.
authors: Emergency Department of Beijing Chao-Yang Hospital, Affiliated to Capital Medical University, Chaoyang District, Beijing 100020, China. Electronic address: 13581960936@139.com.
authors: Yun-Xia
authors: YX
authors: Chen
authors: Emergency Department of Beijing Chao-Yang Hospital, Affiliated to Capital Medical University, Chaoyang District, Beijing 100020, China. Electronic address: lcscyyy@wo.com.cn.
authors: Chun-Sheng
authors: CS
authors: Li
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D012720:Severity of Illness Index
chemical_list: D019344:Lactic Acid