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J Crit Care. 2014 Jun;29(3):334-9. doi: 10.1016/j.jcrc.2013.12.017. Epub 2014 Jan 4.

Prognosis of emergency department patients with suspected infection and intermediate lactate levels: a systematic review.

Author information

1
Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS.
2
Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS. Electronic address: aejones@umc.edu.

Abstract

PURPOSE:

Previous studies have shown a correlation between blood lactate greater than 4.0 mmol/L and mortality in patients with suspected infection in the emergency department (ED), but data are more limited regarding the prognosis of intermediate blood lactate (2.0-3.9 mmol/L), particularly in the absence of hemodynamic instability. We sought to quantify the prognostic significance of intermediate blood lactate levels in ED patients with suspected infection, emphasizing patients without hypotension.

METHODS:

A systematic review of 4 databases was conducted to identify studies using a comprehensive search strategy. All studies performed on adult ED patients with suspected infection and available data on hemodynamics, intermediate lactate levels, and mortality rates were included.

RESULTS:

We identified 20 potential publications, 8 of which were included. Intermediate lactate elevation was found in 11,062 patients with suspected or confirmed infection, 1672 (15.1%) of whom died. Subgroup analysis of normotensive patients demonstrated a mortality of 1561 (14.9%) of 10,442, with rates from individual studies between 3.2% and 16.4%.

CONCLUSION:

This systematic review found that among ED patients with suspected infection, intermediate lactate elevation is associated with a moderate to high risk of mortality, even among patients without hypotension. Physicians should consider close monitoring and aggressive treatment for such patients.

KEYWORDS:

Infection; Lactate; Prognosis; Review

PMID:
24559577
DOI:
10.1016/j.jcrc.2013.12.017
[Indexed for MEDLINE]
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