Initial venous lactate levels as a predictor of mortality in severe sepsis: a single-center retrospective cohort study

Sepsis is the most common cause of death among critically ill patients.[1] Accordingly, most patients with sepsis are diagnosed and initially treated in the emergency department (ED).[2] Moreover, some studies have shown that early resuscitation is an important determinant of sepsis survival.[2,3] Elevated serum lactate levels, which have been observed even during hemodynamic stability, have been considered an important marker of impaired tissue perfusion among sepsis patients. Some studies have established lactate levels as diagnostic, therapeutic, and prognostic indicators of tissue perfusion in sepsis.[4,5] Previous studies have also shown that elevated blood lactate levels were associated with an increased risk of death. [4,5] Increased blood lactate levels have been used to identify critically ill patients at high risk of death even before the development of hemodynamic instability.[6-9] Scott et al[7] observed a 3-fold increase in 30-d mortality in children with a venous lactate level >36 mg/dL. Early venous lactate levels assist in the assessment of sepsis severity. Venous lactate levels are able to predict outcomes among patients with sepsis. Venous lactate levels are more manageable and less painful to determine compared to arterial samples.[10] The peripheral venous lactate levels may serve as an alternative to arterial blood lactate measurements to predict in-hospital mortality.[8,9] Blood lactate levels can be measured by various devices (central laboratory, point-of-care blood gas analyzer). Most devices used at the bedside have acceptable limits of agreement compared to central laboratory devices.[10] This study aimed to compare the predictability of venous lactate to other measures, such as arterial lactate, Sequential Organ Failure Assessment (SOFA), quick SOFA (qSOFA), and systemic inflammatory response syndrome (SIRS) criteria, to predict 28-d hospital mortality and morbidity in patients with sepsis admitted to the ED. © 2017 22 World Journal of Emergency Medicine.