title: The prognostic role of non-critical lactate levels for in-hospital survival time among ED patients with sepsis.
abstract: OBJECTIVE
  This study describes emergency department (ED) sepsis patients with non-critical serum venous lactate (LAC) levels (LAC <4.0 mmol/L) who suffered in-hospital mortality and examines LAC in relation to survival times.
  
  
  METHODS
  An ED based retrospective cohort study accrued September 2010 to August 2014. Inclusion criteria were ED admission, LAC sampling, >2 systemic inflammatory response syndrome criteria with an infectious source (sepsis), and in-hospital mortality. Kaplan-Meier curves were used for survival estimates. An a priori sub-group analysis for patients with repeat LAC within 6 hours of initial sampling was undertaken. The primary outcome was time to in-hospital death evaluated using rank-sum tests and regression models.
  
  
  RESULTS
  One hundred ninety-seven patients met inclusion criteria. Pulmonary infections were the most common (44%) and median LAC was 1.9 mmol/L (1.5, 2.5). Thirteen patients (7%) died within 24 hours and 79% by ≤28 days. Median survival was 11 days (95% CI, 8.0-13). Sixty-two patients had repeat LAC sampling with 14 (23%) and 48 (77%) having decreasing increasing levels, respectively. No significant differences were observed in treatment requirements between the LAC subgroups. Among patients with decreasing LAC, median survival was 24 days (95% CI, 5-32). For patients with increasing LAC median survival was significantly shorter (7 days; 95% CI, 4-11, P = .04). Patients with increasing LAC had a non-significant trend toward reduced survival (HR = 1.6 95% CI, 0.90-3.0, P = .10).
  
  
  CONCLUSIONS
  In septic ED patients experiencing in-hospital death, non-critical serum venous lactate may be utilized as a risk-stratifying tool for early mortality, while increasing LAC levels may identify those in danger of more rapid deterioration.
authors.affiliation: Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY. Electronic address: adam.aluisio@gmail.com.
authors.forename: Adam R
authors.initials: AR
authors.lastname: Aluisio
authors.affiliation: Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Ashika
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Bonny J
authors.initials: BJ
authors.lastname: Baron
authors.affiliation: Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Saman
authors.initials: S
authors.lastname: Sarraf
authors.affiliation: Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Richard
authors.initials: R
authors.lastname: Sinert
authors.affiliation: Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Eric
authors.initials: E
authors.lastname: Legome
authors.affiliation: Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY.
authors.forename: Shahriar
authors.initials: S
authors.lastname: Zehtabchi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007773:Lactates / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000401:mortality* / Q000628:therapy
chemical_list: D015415:Biomarkers; D007773:Lactates