Agreement between capillary and venous lactate in patient with sepsis and septic shock presenting to emergency department of Lampang hospital
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Abstract
BACKGROUND:Sepsis is a commoncondition in the emergency department (ED). Resuscitation to normalized blood lactate in high blood lactate patientscan decrease mortality rate. Capillary lactate (C-lactate) measurement with point of care test (POCT) instead of peripheral venous lactate(V-lactate) wound reduce time to diagnosis.
OBJECTIVE:This study aimed to investigate agreement between C-lactate and V-lactate measured using a POCT in septic patients in the ED.
METHODS:This is a prospective cross-sectional, diagnostic accuracy study of 207 ED patients with suspected sepsis in the ED at Lampang hospital taking paired C-lactate and V-lactate measured using a POCT between January 2020 and April 2022. The agreement between the paired measurements was assessed using binary regression analysis and modified Bland-Altman plot. The significance level was set at p-value ≤ 0.05.
RESULTS:A total of 207 paired samples were collected. The C-lactate and V-lactate were good correlated (r = 0.81). The mean difference between C-lactate and V-lactate was 1.07 mmol/L with 95% limit of agreement of -3.89 to 6.03 mmol/L. C-lactate ≥ 4 mmol/L can predict V-lactate level ≥ 4 mmol/L with a sensitivity of 90.91% (95%CI, 82.20-96.30) a specificity of 70.77% (95%CI, 62.20-78.40) and the area under receiver operating characteristic curve was 0.81 (95%CI, 0.76-0.86).
CONCLUSIONS AND RECOMMENDATIONS:The study demonstrated that theagreement between C-lactate and V-lactate was good and C-lactate can be used as a substitute for V-lactate measurement in septic patients. The C-lactate ≥ 4 mmol/L may be used for predicting the V-lactate ≥ 4 mmol/L.
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