Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

Academic Emergency Medicine

Abstract

Background and Objectives: Studies demonstrate that patients in septic shock with a lactate <2 have a mortality between 20% to 46%. Our prior work reported that in emergency department (ED) patients with a second lactate ≥2 (lac), there is a two-fold increase in 30-day mortality when compared to patients with a second lactate <2 (alac). On secondary analysis, we found that intubated patients with a second lactate ≤2 had a longer hospital length of stay (LOS). Our objective is to further scrutinize this 30-day mortality and LOS. Methods: This is a retrospective cohort study of an eight-hospital health system using data from the electronic medical record. Inclusion criteria consisted of patients ≥18 years of age who presented to the ED from 1/1/2017 to 11/30/2022 with ≥2 lactate levels measured in the ED, were diagnosed with sepsis, and admitted to the intensive care unit (ICU) within 24 h. We excluded lactate auto-expressors, pregnant patients, transfers, and those taken for a surgical procedure within 72 h of presentation. Patients were classified based on initial and second lactate as <2 (alac) or ≥2 (lac). Multivariable regression analysis was performed for 30-day mortality and LOS, adjusting for vitals, BMI, DNR status, and intubation timing. Results: Of the 3100 patients who met inclusion criteria, 1285 patients were intubated and categorized based on their lactate expression: alac -> alac (reference; 111/1285, 8.9%), alac -> lac (28/1285, 2.2%), lac -> alac (259/1285, 20.2%), and lac -> lac (887/1285, 69.0%). Lac -> lac had a significantly higher 30-day mortality (OR = 2.058, 95% CI = [1.353–3.154]) compared to alac -> alac. Lac -> alac had a significantly increased LOS (OR = 1.133 (95% CI = [1.003–1.280]) compared to alac -> alac. Other group comparisons for 30-day mortality and LOS were not significant. Conclusion: Intubated sepsis and septic shock patients in the lac -> lac group had a two-fold increase in 30-day mortality when compared to alac -> alac. The lac -> alac group had a 13% greater LOS compared to alac -> alac. However, no further associations existed between the lactate expression category and LOS. Our prior work did not adjust for DNR and intubation timing, which may have spuriously augmented the LOS differences.

Volume

31

Issue

S1

First Page

156

Comments

Society for Academic Emergency Medicine SAEM Annual Meeting, May 14-17, 2024, Phoenix, AZ

DOI

10.1111/acem.14533

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