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{
    "pk": 9959,
    "title": "Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection",
    "subtitle": null,
    "abstract": "ABSTRACT \n \nINTRODUCTION\n \nLactate levels are increasingly used to risk stratify emergency department (ED) patients with and without infection. Whether a serum lactate provides similar prognostic value across diseases is not fully elucidated. This study assesses the prognostic value of serum lactate in ED patients with and without infection to both report and compare relative predictive value across etiologies.\n \nMETHODS\n \nWe conducted a prospective, observational study of ED patients displaying abnormal vital signs (AVS) (heart rate ≥130 bpm, respiratory rate ≥24 bpm, shock index ≥1, and/or systolic blood pressure <90 mmHg). The primary outcome, deterioration, was a composite of acute renal failure, non-elective intubation, vasopressor administration or in-hospital mortality.\n \nRESULTS\n \nOf the 1152 patients with AVS who were screened, 488 patients met the current study criteria: 34% deteriorated and 12.5% died. The deterioration rate was 88/342 (26%, 95% CI: 21 – 30%) for lactate < 2.5 mmol/L, 47/90 (52%, 42 – 63%) for lactate 2.5 – 4.0 mmol/L, and 33/46 (72%, 59 – 85%) for lactate >4.0mmol/L. Trended stratified lactate levels were associated with deterioration for both infected (p<0.01) and non-infected (p<0.01) patients. In the logistic regression models, lactate > 4mmol/L was an independent predictor of deterioration for patients with infection (OR 4.8, 95% CI: 1.7 – 14.1) and without infection (OR 4.4, 1.7 – 11.5).\n \nCONCLUTION\nLactate levels can risk stratify patients with AVS who have increased risk of adverse outcomes regardless of infection status.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "emergency department"
        },
        {
            "word": "lactate"
        },
        {
            "word": "Risk-stratification"
        },
        {
            "word": "Infection"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/4391g55t",
    "frozenauthors": [
        {
            "first_name": "Kimie",
            "middle_name": "",
            "last_name": "Oedorf",
            "name_suffix": "",
            "institution": "Aarhus Universitetshospital, Nørrebrogade 44, Bygning 30, 1. sal, DK-8000 Aarhus C\n\nBeth Israel Deaconess Medical Center 330 Brookline Avenue, Boston, MA 02215",
            "department": "None"
        },
        {
            "first_name": "Danielle",
            "middle_name": "E.",
            "last_name": "Day",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center 330 Brookline Avenue, Boston, MA 02215",
            "department": "None"
        },
        {
            "first_name": "Yotam",
            "middle_name": "",
            "last_name": "Lior",
            "name_suffix": "",
            "institution": "Clinical Research Center Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.",
            "department": "None"
        },
        {
            "first_name": "Victor",
            "middle_name": "",
            "last_name": "Novack",
            "name_suffix": "",
            "institution": "Clinical Research Center Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.",
            "department": "None"
        },
        {
            "first_name": "Leon",
            "middle_name": "D.",
            "last_name": "Sanchez",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center 330 Brookline Avenue, Boston, MA 02215",
            "department": "None"
        },
        {
            "first_name": "Richard",
            "middle_name": "E.",
            "last_name": "Wolfe",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center 330 Brookline Avenue, Boston, MA 02215",
            "department": "None"
        },
        {
            "first_name": "Hans",
            "middle_name": "",
            "last_name": "Kirkegaard",
            "name_suffix": "",
            "institution": "Aarhus Universitetshospital, Nørrebrogade 44, Bygning 30, 1. sal, DK-8000 Aarhus C",
            "department": "None"
        },
        {
            "first_name": "Nathan",
            "middle_name": "I.",
            "last_name": "Shapiro",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center 330 Brookline Avenue, Boston, MA 02215",
            "department": "None"
        },
        {
            "first_name": "Daniel",
            "middle_name": "J",
            "last_name": "Henning",
            "name_suffix": "",
            "institution": "Beth Israel Deaconess Medical Center 330 Brookline Avenue, Boston, MA 02215",
            "department": "None"
        }
    ],
    "date_submitted": "2016-06-28T17:45:55Z",
    "date_accepted": "2016-06-28T17:45:55Z",
    "date_published": "2016-12-07T17:46:18Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/9959/galley/5458/download/"
        }
    ]
}