Early Recognition and Treatment of Sepsis After the Addition of Lactate to the Laboratory's Critical Result Call List.
OBJECTIVE
Screening of patients with sepsis is needed to increase recognition and allow for earlier interventions. There is no consensus on whether the addition of lactate to the critical result laboratory's call list should be a standard practice.


METHODS
This was a retrospective cohort study that compared management and outcomes of patients with sepsis having lactate ≥4 mmol/L before (group 1) and after (group 2) the addition of a critical result threshold of lactate of ≥4 mmol/L to the critical result laboratory's call list and its effects on time to antibiotics and intravenous fluids (IVFs).


RESULTS
One hundred twenty-one patients were included. Lactate was higher in group 1 (7.0 ± 4.3 vs 5.6 ± 2.0, P = 0.03). More patients in group 2 received hydrocortisone (1.9% vs 22.4%, P = .001). Hospital mortality, 30-day mortality, and 90-day mortality were significantly lower in group 2 (59.3% vs 32.8%, P = .003; 68.5% vs 37.3%, P ≤ .001; 68.5% vs 41.8%, P = .002). There were no significant differences in total volume of IVFs (2400.8 ± 1720.0 vs 2483.7 ± 2155.7, P = 0.83), time to start IVFs (184.0 ± 283.2 vs 115.6 ± 190.5, P = 0.27), or antibiotics (184.8 ± 187.1 vs 133.7 ± 137.4, P = 0.16).


CONCLUSIONS
Addition of lactate to the critical result laboratory's call list did not lead to a statistically significant improvement in time to IVFs or antibiotics, although the average time to antibiotics and IVFs decreased by 51.1 and 68.4 minutes, respectively. Hospital mortality, 30-day mortality, and 90-day mortality were lower in group 2, which may be, in part, due to increased recognition of severe sepsis by critical result notification and earlier intervention.
1 Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.
Hani I
HI
Kuttab
1 Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.|2 Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL, USA.
Ethan
E
Sterk
2 Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL, USA.|3 Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA.
Megan A
MA
Rech
1 Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.|2 Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL, USA.
Trac
T
Nghiem
1 Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.|4 Department of Pathology, Loyola University Medical Center, Maywood, IL, USA.
Burak
B
Bahar
1 Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.|4 Department of Pathology, Loyola University Medical Center, Maywood, IL, USA.
Stephen
S
Kahn
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D042241:Early Diagnosis; D061345:Early Medical Intervention; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D007755:Laboratories, Hospital; D019344:Lactic Acid / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D016134:Organizational Policy; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D013689:Telephone; D061665:Time-to-Treatment
D000900:Anti-Bacterial Agents; D019344:Lactic Acid
emergency medicine; lab critical result call list; lactate; mortality; sepsis