title: Diagnostic performance of initial serum lactate for predicting bacteremia in female patients with acute pyelonephritis.
abstract: OBJECTIVE
  The purpose of the present study was to investigate the diagnostic value of lactate for predicting bacteremia in female patients with acute pyelonephritis (APN).
  
  
  METHODS
  We conducted a retrospective study of female patients with APN who visited the study hospital emergency department. The demographics, comorbidities, physiologies, and laboratory variables including white blood cell count and segmented neutrophil count, C-reactive protein, and initial serum lactate levels were collected and analyzed to identify associations with the presence of bacteremia.
  
  
  RESULTS
  During the study period, a total of 314 patients were enrolled. One hundred twenty-three patients (39.2%) had bacteremia. Escherichia coli was the most frequent pathogen. Logistic regression analysis demonstrated that the lactate level was independently associated with the presence of bacteremia (odds ratio, 1.39 [95% confidence interval, 1.08-1.78]). The C-statistic of the lactate level was 0.67 (95% CI, 0.60-0.73). At a cutoff value of 1.4mmol/L, the lactate level predicted bacteremia with a sensitivity (53.7%), specificity (72.3%), positive predictive value (55.5%), negative predictive value (70.8%), positive likelihood ratio (1.93), and negative likelihood ratio (0.64).
  
  
  CONCLUSIONS
  The initial serum lactate level showed poor discriminative performance for predicting bacteremia in female patients with APN.
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
authors.forename: Dong Young
authors.initials: DY
authors.lastname: Seo
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea. Electronic address: akynei@naver.com.
authors.forename: Sion
authors.initials: S
authors.lastname: Jo
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
authors.forename: Jae Baek
authors.initials: JB
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Jin
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
authors.forename: Taeoh
authors.initials: T
authors.lastname: Jeong
authors.affiliation: Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
authors.forename: Jaechol
authors.initials: J
authors.lastname: Yoon
authors.affiliation: National Cancer Control Institute, National Cancer Center, Goyang-si, Kyunggi-do, Republic of Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Park
mesh_terms: D000208:Acute Disease; D000368:Aged; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007773:Lactates / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011704:Pyelonephritis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D007773:Lactates