TY  - JOUR
AV  - public
UR  - http://doi.org/10.1136/bmjopen-2024-091789
ID  - uneatlantico15984
TI  - Novel prehospital lactate cut-off estimation for mortality: a multicentre observational study
N2  - 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.
Y1  - 2024/12//
JF  - BMJ Open
A1  - Martín-Rodríguez, Francisco
A1  - Sanz-Garcia, Ancor
A1  - Zalama-Sánchez, Daniel
A1  - de Santos Castro, Pedro Ángel
A1  - Silva Alvarado, Eduardo René
A1  - Gracia Villar, Santos
A1  - Dzul López, Luis Alonso
A1  - Aparicio Obregón, Silvia
A1  - Calderón Iglesias, Rubén
A1  - del Pozo Vegas, Carlos
A1  - López-Izquierdo, Raúl
SN  - 2044-6055
IS  - 12
VL  - 14
ER  -