Tighter precision target required for lactate testing in patients with lactic acidosis.

Background: Allowable analytic errors are generally based on biologic variation in normal, healthy subjects. Some analytes like blood lactate have low concentrations in healthy individuals and resultant allowable variation is large when expressed as a coefficient of variation (CV). In Ricós' compendium of biologic variation, the relative pooled intra-individual lactate variation (si) averages 27% and the desirable imprecision becomes 13.5%. We derived biologic variability (sb) from consecutive patient data and demonstrate that sb of lactate is significantly lower.

Methods: A data repository provided lactate results measured over 18 months in the General Systems intensive care unit (ICU) at the University of Alberta Hospital in Edmonton, Canada. In total 54,000 lactate measurements were made on two point-of-care Radiometer 800 blood gas systems operated by Respiratory Therapy. The standard deviations of duplicates (SDD) were tabulated for the intra-patient lactates that were separated by 0-1, 1-2...up to 16 h. The graphs of SDD vs. time interval were approximately linear; the y-intercept provided by the linear regression represents the sum of sb and short-term analytic variation (sa):y₀=(sa²+sb²)½. The short-term sa was determined from imprecisions provided by Radiometer and confirmed with onsite controls. The derivation of sb was performed for multiple patient ranges of lactate.

Results: The relative desirable lactate imprecision for patients with lactic acidosis is about half that of normal individuals.

Conclusions: As such, evaluations of lactate measurements must use tighter allowable error limits.