Objectives: Serum lactate levels are a useful tool in monitoring critically ill patients, especially those who are septic. However, lactate levels are often not routinely drawn or rapidly available in some institutions. The objective of this study was to determine if a readily available anion gap (AG) could be used as a surrogate marker for abnormal lactate level in Emergency Department (ED) patients at risk for sepsis.
Methods: Prospective, observational cohort study of consecutive ED patients seen at an urban university tertiary care referral center with 46,000 annual ED visits. ED patients aged 18 years or older presenting with clinically suspected infection were eligible for enrollment if a serum chemistry and lactate levels were drawn during the ED visit. During the 9-month study period, 1419 patients were enrolled. The initial basic chemistry panels, calculated AG, and lactate levels drawn in the ED were collected. We defined, a priori, an AG > 12 and a lactate > 4 mmol/L to be abnormal. Analysis was performed with Student's t-test, operating characteristics with 95% confidence intervals, and logistic regression.
Results: The mean AG was 11.8 (SD 3.6) and the mean lactate was 2.1 (SD 1.3). For an AG > 12, the mean lactate was 2.9 (SD 1.7), compared with 1.8 (SD 0.8) for an AG < 12. The sensitivity of an elevated AG (> 12) in predicting elevated lactate levels (> 4 mmol/L) was 80% (72-87%) and the specificity was 69% (66-71%). Patients with a gap > 12 had a 7.3-fold (4.6-11.4) increased risk of having a lactate > 4 mmol/L. The area under the curve was 0.84.
Conclusion: This study suggests that an elevated AG obtained in the ED is a moderately sensitive and specific means to detect elevated lactate levels in ED patients at risk for sepsis. This information may be somewhat helpful to Emergency Physicians to risk-stratify their patients to provide more aggressive early resuscitation.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jemermed.2007.12.020 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Influence of puberty on high intensity exercise induced skeletal muscle damage and inflammatory response in sedentary boys.
Sports Med Health Sci
March 2025
Sports and Exercise Physiology Laboratory, Department of Physiology, University of Calcutta, University Colleges of Sciences and Technology, 92 A.P.C. Road, Kolkata, 700009, India.
The present investigation examined the influence of age and pubertal transition on magnitude of muscle damage and inflammatory response following high intensity incremental treadmill running till volitional exhaustion in sixty-four sedentary prepubertal ( = 32) and postpubertal ( = 32) boys who were randomly recruited in the study. Muscle damage and inflammatory markers like creatine kinase (CK), lactate dehydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotranferase (AST), C-Reactive Protein (CRP) and Interleukin-6 (IL-6) were estimated before and after exercise. Serum CK, LDH, AST, ALT, CRP and IL-6 levels significantly increased after exercise in both the groups in comparison to respective pre-exercise values.
View Article and Find Full Text PDFBiodegradable copper-doped calcium phosphate nanoplatform enables tumor microenvironment modulations for amplified ferroptosis in cervical carcinoma treatment.
Int J Pharm X
June 2025
Department of Gynecology, The Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, PR China.
As a recently discovered form of regulated cell death, ferroptosis has attracted much attention in the field cancer therapy. However, achieving considerably enhanced efficacy is often restricted by the overexpression of endogenous glutathione (GSH) in tumor microenvironment (TME). In this work, we report a ferroptosis-inducing strategy of GSH depletion and reactive oxygen species (ROS) generation based on a biodegradable copper-doped calcium phosphate (CaP) with L-buthionine sulfoximine (BSO) loading (denoted as BSO@CuCaP-LOD, BCCL).
View Article and Find Full Text PDFPrognostic accuracy of lactate and procalcitonin in addition to national early warning score in patients with suspected sepsis - A cross-sectional study in a tertiary care center.
Int J Crit Illn Inj Sci
December 2024
Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Background: Sepsis, a major global health concern, leads to millions of deaths annually, hence the need for early and reliable prognostic tools to assess patient risk and guide clinical decision making becomes crucial. This cross-sectional study evaluated the prognostic accuracy of integrating blood lactate and serum procalcitonin (PCT) levels with the National Early Warning Score (NEWS) for predicting mortality in sepsis patients. The objective was to assess whether this lactate and procalcitonin integrated with NEWS score (LP NEWS) could serve as a more effective early prognostic tool compared to established severity scores.
View Article and Find Full Text PDFLactate accumulation promotes immunosuppression and fibrotic transformation of bone marrow microenvironment in myelofibrosis.
J Transl Med
January 2025
Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Catania, Italy.
Background: Clonal myeloproliferation and fibrotic transformation of the bone marrow (BM) are the pathogenetic events most commonly occurring in myelofibrosis (MF). There is great evidence indicating that tumor microenvironment is characterized by high lactate levels, acting not only as an energetic source, but also as a signaling molecule.
Methods: To test the involvement of lactate in MF milieu transformation, we measured its levels in MF patients' sera, eventually finding a massive accumulation of this metabolite, which we showed to promote the expansion of immunosuppressive subsets.
Predictors of 7-day mortality in critically ill patients with hyperglycemic crisis : A single center retrospective analysis.
Wien Klin Wochenschr
January 2025
Department of Medicine III and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Klinik Hietzing, Vienna, Austria.
Aim/hypothesis: The main aim of the study was to identify point of care available laboratory and clinical predictors of 7‑day mortality in critically ill patients with a hyperglycemic crisis.
Methods: A retrospective study of 990 patients with the first hospitalization due to hyperglycemia was performed. Patients were classified as having diabetic ketoacidosis (DKA) or being in a hyperosmolar hyperglycemic state (HHS) according to the recommendations of the American Diabetes Association (ADA).
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!