• Nathan I Shapiro, Christopher Fisher, Michael Donnino, Lauren Cataldo, Aimee Tang, Stephen Trzeciak, Gary Horowitz, and Richard E Wolfe.
• Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02116, USA.
• J Emerg Med. 2010 Jul 1;39(1):89-94.

BackgroundPrior studies show that lactate is a useful prognostic marker in sepsis.ObjectiveTo study the feasibility and accuracy of a point-of-care (POC) analyzer capable of performing bedside serum lactate measurements; and to determine if other measurements (pH, base excess) are predictive of mortality.MethodsDesignprospective cohort study of adult (age 18 years or older) Emergency Department (ED) patients with suspected infection during the study period of May 2006 through March 2007.SettingA 55,000-annual-visit urban tertiary care ED.InterventionA point-of-care device (i-STAT, Abbott Point of Care Inc., Princeton, NJ) was deployed using a standardized training and quality assurance process. Using POC testing, we measured serum lactate, pH, and base excess, as well as concomitant lactate measurement via a central laboratory.StatisticsArea under the curve (AUC) for receiver operator characteristic curve, Bland-Altman statistics along with a correlation coefficient, and relative risk with 95% confidence intervals reported.ResultsThere were 699 patients enrolled, of whom 34 (4.9%) died. The AUCs for mortality prediction were: POC lactate 0.72, laboratory lactate 0.70, pH measurement 0.60, and base excess 0.60. Bland-Altman showed that POC lactate was, on average, 0.32 (95% confidence interval -0.35-0.98) lower than laboratory lactate, with agreement kappa = 0.97.ConclusionsA point-of-care testing device provides a reliable and feasible way to measure serum lactate at the bedside. The pH and base excess were less helpful.Copyright 2010 Elsevier Inc. All rights reserved.

17 keywords...

hide…