Early Lactate Dynamics in Critically Ill Non-Traumatic Patients in a Resuscitation Room of a German Emergency Department (OBSERvE-Lactate-Study)

Publication date: Available online 8 December 2018

Source: The Journal of Emergency Medicine

Author(s): Andre Kramer, Norman Urban, Stephanie Döll, Thomas Hartwig, Maryam Yahiaoui-Doktor, Ralph Burkhardt, Sirak Petros, André Gries, Michael Bernhard

Abstract

Background

Management of critically ill non-trauma patients in the resuscitation room of an emergency department (ED) is very challenging, and it is difficult to identify patients with a higher risk of death. Previous studies have shown that lactate indices can predict survival for selected diseases and syndromes.

Objective

As reported for other patient populations, we set out to determine whether admission lactate or lactate dynamics (LD) within 24 h can predict 30-day mortality in unselected critically ill non-traumatic patients.

Methods

In this retrospective study over a 1-year period, admission lactate, time weighted average lactate (Lac_TW) and LD of all critically ill adult patients admitted from ED to intensive care unit were analyzed. A linear regression model was implemented to estimate lactate data 1 h after admission.

Results

The admission lactate, Lac_TW, and LD within 24 h were analyzed from 392 critically ill patients. The overall 30-day mortality rate was around 29%. Admission lactate (4.1 ± 4.0 mmol/L vs. 6.6 ± 6.1 mmol/L; p < 0.01) and Lac_TW (1.8 ± 1.7 mmol/L vs. 4.1 ± 4.8 mmol/L; p < 0.01) were different between survivors and non-survivors. LD between survivors and non-survivors did not differ at 1 h, 6 h, 12 h, or 24 h. After excluding patients with out-of-hospital or in-hospital cardiac arrest during resuscitation room management, admission lactate and LD between survivors and non-survivors did not differ at 1 h, 12 h, and 24 h. LD at 6 h (44% ± 42% vs. 33% ± 58%; p = 0.042) and Lac_TW (1.7 ± 1.6 mmol/L vs. 2.6 ± 3.0 mmol/L; p < 0.01) did differ.

Conclusions

In critically ill ED patients initially requiring treatment in a resuscitation room setting, LD at 6 h and Lac_TW may predict their survival beyond 30 days. These findings need to be confirmed in a prospective study design.

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