title: Lactate - Arterial and Venous Agreement in Sepsis: a prospective observational study.
abstract: BACKGROUND
  Sepsis is a common condition in the emergency department (ED). Lactate measurement is an important part of management: arterial lactate (A-LACT) measurement is the gold standard. There is increasing use of peripheral venous lactate (PV-LACT); however, there is little research supporting the interchangeability of the two measures.If PV-LACT has good agreement with A-LACT, it would significantly reduce patient discomfort and the risks of arterial sampling for a large group of acutely unwell patients, while allowing faster and wider screening, with potential reduced costs to the healthcare system.
  
  
  OBJECTIVE
  The aim of this study is to determine the agreement between PV-LACT and A-LACT in septic patients attending the ED.
  
  
  METHODS
  We carried out a prospective observational cohort study of 304 consented patients presenting with sepsis to a single UK NHS ED (110 000 adult attendances annually) taking paired PV-LACT and A-LACT. Bland-Altman analysis was carried out to determine agreement. Receiver operating characteristic curves and 2×2 tables were constructed to explore the predictive value of PV-LACT for A-LACT.
  
  
  RESULTS
  The mean difference (PV-LACT-A-LACT) is 0.4 mmol/l [95% confidence interval (CI): 0.37-0.45], with 95% limits of agreement from -0.4 (95% CI: -0.45 to -0.32) to 1.2 (95% CI: 1.14-1.27). A PV-LACT of at least 2 mmol/l predicts an A-LACT of at least 2 with 100% sensitivity (95% CI: 89-100%) and 83% specificity (95% CI: 77-87%).
  
  
  CONCLUSIONS
  This study is the largest comparing the two measurements, and shows good clinical agreement. We recommend using PV-LACT in the routine screening of septic patients. A PV-LACT less than 2 mmol/l is predictive of an A-LACT less than 2 mmol/l.
authors.affiliation: Emergency Medicine Research Group Edinburgh, Department of Emergency Medicine.|Department of Emergency Medicine, Royal Infirmary of Edinburgh.
authors.forename: Deepankar
authors.initials: D
authors.lastname: Datta
authors.affiliation: Emergency Medicine Research Group Edinburgh, Department of Emergency Medicine.|Department of Emergency Medicine, Royal Infirmary of Edinburgh.
authors.forename: Julia
authors.initials: J
authors.lastname: Grahamslaw
authors.affiliation: Emergency Medicine Research Group Edinburgh, Department of Emergency Medicine.|Department of Emergency Medicine, Royal Infirmary of Edinburgh.
authors.forename: Alasdair J
authors.initials: AJ
authors.lastname: Gray
authors.affiliation: Wellcome Trust Clinical Research Facility, Western General Hospital, Edinburgh, Scotland, UK.
authors.forename: Catriona
authors.initials: C
authors.lastname: Graham
authors.affiliation: Department of Emergency Medicine, Royal Infirmary of Edinburgh.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Walker
mesh_terms: D001158:Arteries / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000378:metabolism*; D006113:United Kingdom
chemical_list: D015415:Biomarkers; D019344:Lactic Acid