Clinical Utility of Delta Lactate for Predicting Early In-Hospital Mortality in Adult Patients: A Prospective, Multicentric, Cohort Study

• Published in: Diagnostics (Basel) 2020-11, Vol.10 (11), p.960
• Main Authors: Brio-Ibañez, Pablo del, López-Izquierdo, Raúl, Martín-Rodríguez, Francisco, Mohedano-Moriano, Alicia, Polonio-López, Begoña, Maestre-Miquel, Clara, Viñuela, Antonio, Durantez-Fernández, Carlos, Villamor, Miguel Á. Castro, Martín-Conty, José L.
• Format: Article
• Language: English
• Subjects: Age; biomarker; Cohort analysis; critical care; Data collection; emergency department; emergency medical services; Informed consent; lactate clearance; Mortality; Pathology; Patients; Physiology; prognosis; Statistical analysis; Variables
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics10110960

One of the challenges in the emergency department (ED) is the early identification of patients with a higher risk of clinical deterioration. The objective is to evaluate the prognostic capacity of ΔLA (correlation between prehospital lactate (pLA) and hospital lactate (hLA)) with respect to in-hospital two day mortality. We conducted a pragmatic, multicentric, prospective and blinded-endpoint study in adults who consecutively attended and were transported in advanced life support with high priority from the scene to the ED. The corresponding area under the receiver operating characteristics curve (AUROC) was obtained for each of the outcomes. In total, 1341 cases met the inclusion criteria. The median age was 71 years (interquartile range: 54–83 years), with 38.9% (521 cases) females. The total 2 day mortality included 106 patients (7.9%). The prognostic precision for the 2 day mortality of pLA and hLA was good, with an AUROC of 0.800 (95% CI: 0.74–0.85; p < 0.001) and 0.819 (95% CI: 0.76–0.86; p < 0.001), respectively. Of all patients, 31.5% (422 cases) had an ΔLA with a decrease of