Novel prehospital lactate cut-off estimation for mortality: a multicentre observational study

Martín-Rodríguez, Francisco and Sanz-Garcia, Ancor and Zalama-Sánchez, Daniel and de Santos Castro, Pedro Ángel and Silva Alvarado, Eduardo René and Gracia Villar, Santos and Dzul López, Luis Alonso and Aparicio Obregón, Silvia and Calderón Iglesias, Rubén and del Pozo Vegas, Carlos and López-Izquierdo, Raúl UNSPECIFIED, UNSPECIFIED, UNSPECIFIED, UNSPECIFIED, eduardo.silva@funiber.org, santos.gracia@uneatlantico.es, luis.dzul@uneatlantico.es, silvia.aparicio@uneatlantico.es, ruben.calderon@uneatlantico.es, UNSPECIFIED, UNSPECIFIED (2024) Novel prehospital lactate cut-off estimation for mortality: a multicentre observational study. BMJ Open, 14 (12). e091789. ISSN 2044-6055

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Abstract

Objectives: Point-of-care testing available in prehospital settings requires the establishment of new medical decision points. The aim of the present work was to determine the cut-off of the lactate threshold that activates alert triggers for all-cause 2-day mortality. Design: Multicentre, prospective, ambulance-based, observational study. Setting: Patients treated via emergency medical services (EMSs) and delivered to the emergency department between 2019 and 2023 were selected in Spain. Participants: Adults with any acute disease. Primary and secondary outcome measures: Epidemiological data, vital signs and prehospital point-of-care glucose and lactate levels were obtained. The outcome was all-cause 2-day in-hospital mortality. The cut-offs were obtained via three different methods: (i) indirect (which considers survivors and non-survivors), direct (which considers only survivors) assessment and lactate quartile. Additionally, the quartile approach was used to determine the differences in lactate distribution between survivors and non-survivors. Three different back-to-back studies with the same methodology were used. Results: A total of 11 713 patients fulfilled the inclusion criteria. The mortality rate was 4.6% (542 patients). The difference in the median prehospital lactate concentration (mmol/L) between survivors and non-survivors was statistically significant (p<0.001): 2.29 (95% CI 1.43 to 3.38) and 7.14 (95% CI 5.11 to 9.71), respectively. Globally, the cut-off for all the studies combined was estimated by the direct method to be 3.71 mmol/L (95% CI 2.92 to 3.91), which was similar to the indirect value of 3.07 (95% CI 2.95 to 5.49) and the third quartile of 4.00. The mortality rate in patients who were less than 3.71 mmol/L was 0.004%, and that above that cut-off was 18%. Conclusions: This study established a real-world lactate cut-off for 2-day in-hospital mortality of 3.71 mmol/L (95% CI 2.92 to 3.91) on the basis of data from the EMS. Considering this cut-off point could improve patient management via EMS services, allowing quick identification of patients at high risk of clinical worsening.

Item Type:	Article
Subjects:	Subjects > Biomedicine
Divisions:	Europe University of Atlantic > Research > Scientific Production
Depositing User:	Sr Bibliotecario
Date Deposited:	07 Jan 2025 12:26
Last Modified:	07 Jan 2025 12:26
URI:	http://repositorio.funiber.org/id/eprint/15984

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