title: Peripheral venous lactate at admission is associated with in-hospital mortality, a prospective cohort study.
abstract: BACKGROUND
  The prognostic value of blood lactate as a predictor of adverse outcome in the acutely ill patient is unclear. The aim of this study was to investigate if a peripheral venous lactate measurement, taken at admission, is associated with in-hospital mortality in acutely ill patients with all diagnosis. Furthermore, we wanted to investigate if the test improves a triage model in terms of predicting in-hospital mortality.
  
  
  METHODS
  We retrieved a cohort of 2272 adult patients from a prospectively gathered acute admission database. We performed regression analysis to evaluate the association between the relevant covariates and the outcome measure: in-hospital mortality.
  
  
  RESULTS
  Lactate as a continuous variable was a risk for in-hospital mortality with an odds ratio (OR) of 1.40 [95% confidence interval (CI) 1.25-1.57, P<0.0001]. OR for in-hospital mortality increased with increasing lactate levels from 2.97 (95% CI 1.55-5.72, P<0.001) for lactate between 2 mmol/l and 4 mmol/l, to 7.77 (95% CI 3.23-18.66, P<0.0001) for lactate>4 mmol/l. If the condition was non-compensated (i.e. pH<7.35), OR for in-hospital mortality increased to 19.99 (7.26-55.06, P<0.0001). Patient with a blood lactate at 4 mmol/l or more had a risk of in-hospital mortality equivalent to the patients in the most urgent triage category.
  
  
  CONCLUSIONS
  We found elevated admission peripheral venous lactate to be independently associated with in-hospital mortality in the acutely ill patient admitted to the emergency department. Patients with a lactate>4 mmol/l at hospital admission should be considered triaged to the most urgent triage category.
authors: Department of Anaesthesia and Intensive Care, Nordsjaellands Hospital - Hillerød, Hillerød, Denmark.
authors: C
authors: C
authors: Barfod
authors: L H
authors: LH
authors: Lundstrøm
authors: M M P
authors: MM
authors: Lauritzen
authors: J K
authors: JK
authors: Danker
authors: G
authors: G
authors: Sölétormos
authors: J L
authors: JL
authors: Forberg
authors: P A
authors: PA
authors: Berlac
authors: F K
authors: FK
authors: Lippert
authors: K
authors: K
authors: Antonsen
authors: K H W
authors: KH
authors: Lange
mesh_terms: D000140:Acidosis, Lactic / Q000150:complications* / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D014218:Triage; D055815:Young Adult
chemical_list: D019344:Lactic Acid