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Lactate levels in patients with suspected sepsis

Emergency department (ED) sepsis screening algorithms should incorporate a serum lactate cut off of ≥2mmol/L as a threshold for the initiation of interventions and increased monitoring, research concludes.

Emergency department (ED) sepsis screening algorithms should incorporate a serum lactate cut off of ≥2mmol/L as a threshold for the initiation of interventions and increased monitoring, research concludes.

Sepsis
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Specific lactate thresholds for poor outcomes in patients presenting to EDs with suspected sepsis were subject to retrospective analysis.

Outcome data were sourced on 12,349 ED patients over three years from 97 sites across New South Wales, Australia. A total of 8,310 patients had initial serum lactate analysis on presenting to ED.

The researchers hypothesise that raised lactate levels of ≥2mmol/L predict higher risk of in-hospital mortality (IHM) or an intensive care unit (ICU) stay of 72 hours or longer.

The authors categorised lactate levels into ranges: <1, 1 to <2, 2 to <3, 3 to <4 and ≥4mmol/L. Patients who had experienced IHM or were in an ICU for 72 hours were calculated into each lactate category.

The researchers found that IHM increases as lactate level increases. More than 10% of patients with suspected sepsis and with serum lactate of ≥2mmol/L experienced a prolonged ICU stay or died in hospital.

However, the authors recognise that further studies should be carried out in other clinical settings where different algorithms apply.


Shetty AL, Thompson K, Byth K et al (2018) Serum lactate cut-offs as a risk stratification tool for in-hospital adverse outcomes in emergency department patients screened for suspected sepsis. BMJ Open. doi: 10.1136/bmjopen-2016-015492 

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