Artículo Materias > Biomedicina Universidad Europea del Atlántico > Investigación > Artículos y libros Abierto Inglés Objectives: Point-of-care testing available in prehospital settings requires the establishment of new medical decision points. The aim of the present work was to determine the cut-off of the lactate threshold that activates alert triggers for all-cause 2-day mortality. Design: Multicentre, prospective, ambulance-based, observational study. Setting: Patients treated via emergency medical services (EMSs) and delivered to the emergency department between 2019 and 2023 were selected in Spain. Participants: Adults with any acute disease. Primary and secondary outcome measures: Epidemiological data, vital signs and prehospital point-of-care glucose and lactate levels were obtained. The outcome was all-cause 2-day in-hospital mortality. The cut-offs were obtained via three different methods: (i) indirect (which considers survivors and non-survivors), direct (which considers only survivors) assessment and lactate quartile. Additionally, the quartile approach was used to determine the differences in lactate distribution between survivors and non-survivors. Three different back-to-back studies with the same methodology were used. Results: A total of 11 713 patients fulfilled the inclusion criteria. The mortality rate was 4.6% (542 patients). The difference in the median prehospital lactate concentration (mmol/L) between survivors and non-survivors was statistically significant (p<0.001): 2.29 (95% CI 1.43 to 3.38) and 7.14 (95% CI 5.11 to 9.71), respectively. Globally, the cut-off for all the studies combined was estimated by the direct method to be 3.71 mmol/L (95% CI 2.92 to 3.91), which was similar to the indirect value of 3.07 (95% CI 2.95 to 5.49) and the third quartile of 4.00. The mortality rate in patients who were less than 3.71 mmol/L was 0.004%, and that above that cut-off was 18%. Conclusions: This study established a real-world lactate cut-off for 2-day in-hospital mortality of 3.71 mmol/L (95% CI 2.92 to 3.91) on the basis of data from the EMS. Considering this cut-off point could improve patient management via EMS services, allowing quick identification of patients at high risk of clinical worsening. metadata Martín-Rodríguez, Francisco; Sanz-Garcia, Ancor; Zalama-Sánchez, Daniel; de Santos Castro, Pedro Ángel; Silva Alvarado, Eduardo René; Gracia Villar, Santos; Dzul López, Luis Alonso; Aparicio Obregón, Silvia; Calderón Iglesias, Rubén; del Pozo Vegas, Carlos y López-Izquierdo, Raúl mail SIN ESPECIFICAR, SIN ESPECIFICAR, SIN ESPECIFICAR, SIN ESPECIFICAR, eduardo.silva@funiber.org, santos.gracia@uneatlantico.es, luis.dzul@uneatlantico.es, silvia.aparicio@uneatlantico.es, ruben.calderon@uneatlantico.es, SIN ESPECIFICAR, SIN ESPECIFICAR (2024) Novel prehospital lactate cut-off estimation for mortality: a multicentre observational study. BMJ Open, 14 (12). e091789. ISSN 2044-6055