Serum lactate and hospital mortality in emergency critical care: A prospective cohort study
Keywords:
serum lactate, mortality, critically ill patients, emergency departmentAbstract
Background and objectives: Serum lactate is one of the biomarkers that indicate tissue hypoperfusion in compensated shock. In recent years, serum lactate testing has become more common among critically ill patients presenting to the emergency department (ED). This research aimed to investigate the association between serum lactate levels and both mortality and clinical deterioration in critically ill patients.
Methods: This was an observational prospective cohort study of critically ill patients. Hospitalized patients aged ≥18 years who were triaged as MOPH ED level 1 or 2 at the Emergency Department of Nakornping Hospital between January 1 and April 30, 2020, were included. Patients were excluded if they had traumatic injuries, were pregnant, were referred from other hospitals without a serum lactate level, refused admission against medical advice, died in the ED, or met criteria for the Stroke/STEMI fast track. Patients were stratified by initial venous lactate levels into three groups: low (<2 mmol/L), intermediate (2–4 mmol/L), and high (>4 mmol/L). Statistical analysis was performed using multivariable exponential risk regression to predict in-hospital mortality for each group.
Results: A total of 379 patients were included in the study. In-hospital mortality was observed in 17 patients (12.5%) in the normal lactate group, 21 patients (14.2%) in the intermediate group, and 36 patients (37.9%) in the markedly elevated lactate group. After adjusting for variables that significantly differed between groups—such as gender, age over 60 years, systolic blood pressure below 90 mmHg, presence of infection, and underlying diseases—patients in the markedly elevated lactate group (>4 mmol/L) had a 2.77 times higher risk of mortality (95% CI: 1.68–4.55, p < 0.001) compared to those in the normal lactate group (<2 mmol/L), (Adjusted RR 2.77, 95% CI 1.68-4.55, p-value<0.001).
Conclusion: High serum lactate levels are strongly associated with increased in-hospital mortality in critically ill patients. Early lactate measurement may help identify high-risk individuals and guide timely, targeted emergency interventions.
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