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Novel prehospital lactate cut-off estimation for mortality: a multicentre observational study
Francisco Martín-Rodríguez1, Ancor Sanz-Garcia2,3, Daniel Zalama-Sánchez4
1Universidad de Valladolid, Valladolid, Spain.
BMJ Open
|January 14, 2025
Summary
This study identified a lactate threshold of 3.71 mmol/L in prehospital settings to predict 2-day mortality. This finding aids emergency medical services in rapidly identifying high-risk patients for improved clinical management.
Area of Science:
- Emergency Medicine
- Critical Care
- Biochemistry
Background:
- Prehospital point-of-care testing necessitates new medical decision points.
- Lactate levels are emerging biomarkers for patient risk stratification.
Purpose of the Study:
- To establish a lactate cut-off for predicting all-cause 2-day mortality in prehospital settings.
- To inform alert triggers for emergency medical services (EMS).
Main Methods:
- Multicentre, prospective, observational study of adult patients treated by EMS.
- Collected epidemiological data, vital signs, and prehospital lactate levels.
- Determined lactate cut-offs using direct, indirect, and quartile methods.
Main Results:
- 11,713 patients included; 4.6% mortality rate.
- Median prehospital lactate significantly differed between survivors (2.29 mmol/L) and non-survivors (7.14 mmol/L).
- A lactate cut-off of 3.71 mmol/L predicted 2-day mortality (0.004% vs 18% mortality above cut-off).
Conclusions:
- A lactate cut-off of 3.71 mmol/L was established for 2-day in-hospital mortality in prehospital settings.
- This threshold can enhance patient management by enabling rapid identification of high-risk individuals by EMS.
- Facilitates timely intervention and improves clinical outcomes.
