title: High serum lactate level may predict death within 24 hours.
abstract: BACKGROUND
  Unexpected death within 24 hours of admission is a real challenge for the clinician in the emergency room. How to diagnose these patients and the right approach to prevent sudden death with 24 hours is still an enigma. The aims of our study were to find the independent factors that may affect the clinical outcome in the first 24 hours of admission to the hospital.
  
  
  METHODS
  We performed a retrospective study defining unexpected death within 24 hours of admission in our Department of Medicine in the last 6 years. We found 43 patients who died within 24 hours of admission, and compared their clinical and biochemical characteristics to 6055 consecutive patients who were admitted in that period of time and did not die within the first 24 hours of admission. The parameters that were used include gender, age, temperature, clinical and laboratory criteria for SIRS, arterial blood lactate, and arterial blood pH.
  
  
  RESULTS
  Most of the patients who died within 24 hours had sepsis with SIRS. These patients were older (78.6±14.7 vs. 65.2±20.2 years [p<.0001]), had higher lactate levels (8.0±4.8 vs. 2.1±1.8mmol/L [p<.0001]), and lower pH (7.2±0.2 vs. 7.4±0.1 [p<.0001]). Logistic regression analysis found that lactate was the strongest independent parameter to predict death within 24 hours of admission (OR 1.366 [95% CI 1.235-1.512]), followed by old age (OR 1.048 [95% CI 1.048-1.075] and low arterial blood pH (OR 0.007 [CI <0.001-0.147]). When gender was analyzed, pH was not an independent variable in females (only in males).
  
  
  CONCLUSIONS
  The significant independent variable that predicted death within 24 hours of admission was arterial blood lactate level on admission. Older age was also an independent variable; low pH affected only males, but was a less dominant variable. We suggest use of arterial blood lactate level on admission as a bio-marker in patients with suspected sepsis admitted to the hospital for risk assessment and prediction of death within 24 hours of admission.
authors.affiliation: Department of Medicine, Baruch Padeh Poriya Hospital, Bar Ilan University, Lower Galilee 15208, Israel, Tel: +972-4-665-2688.
authors.forename: Arnon
authors.initials: A
authors.lastname: Blum
authors.affiliation: Department of Medicine, Baruch Padeh Poria Hospital, Faculty of Medicine Bar Ilan University, Israel.
authors.forename: Abd Almajid
authors.initials: AA
authors.lastname: Zoubi
authors.affiliation: Department of Medicine, Baruch Padeh Poria Hospital, Faculty of Medicine Bar Ilan University, Israel.
authors.forename: Shiran
authors.initials: S
authors.lastname: Kuria
authors.affiliation: Department of Health Systems Administration, Max Stern Academic College, Emek Yezreel, Lower Galilee 15208 Israel.
authors.forename: Nava
authors.initials: N
authors.lastname: Blum
keywords: Lactate; SIRS