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Prognostic accuracy of using lactate in addition to the quick Sequential Organ Failure Assessment score and the National Early Warning Score for emergency department patients with suspected infection
  1. Jade Julienne1,
  2. Delphine Douillet2,3,
  3. Marie-Sophie Mozziconacci2,
  4. Jean-Christophe Callahan4
  1. 1Emergency Department, CHU de Nantes, Nantes, France
  2. 2Emergency Department, CHU d'Angers, Angers, France
  3. 3UMR MitoVasc CNRS 6015 - INSERM 1083, University of Angers, Angers, France
  4. 4Intensive Care Department, CH Le Mans, Le Mans, France
  1. Correspondence to DrJean-ChristopheCallahan, Intensive Care, Centre Hospitalier du Mans, Le Mans 72037, France; jccallahan{at}ch-lemans.fr

Abstract

Background The aim of this study was to determine whether: (1) the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and National Early Warning Score (NEWS) clinical prediction tools alone, (2) modified versions of these prediction tools that integrate lactate into their scores, or (3) use of the two tools in tandem with lactate better predicts in-hospital 28-day mortality among adult EDpatients with suspected infection.

Methods From 1 January through 31 December 2018, this retrospective cohort study enrolled consecutive adult patients with suspected infection evaluated at two EDs in France. Patients were included if blood cultures were obtained and non-prophylactic antibiotics were administered in the ED. qSOFA, NEWS criteria and lactate measurements were recorded when patients were clinically suspected of having an infection. Two composite scores (lactate qSOFA (LqSOFA) and lactate NEWS (LNEWS)) integrating lactate were created. Diagnostic test performances for predicting in-hospital mortality within 28days were assessed for qSOFA≥2, LqSOFA≥2, qSOFA≥2 or lactate≥2 mmol/L, and for NEWS≥7, LNEWS≥7, and NEWS≥7 or lactate≥2 mmol/L.

Results 1003 patients were included, 130 (13%) of whom had died by day 28. Sensitivities for 28-day mortality were 50% (95%CI41% to 59%) for qSOFA≥2,69% (95% CI60% to 77%) for LqSOFA≥2,77% (95% CI69% to 84%) for qSOFA or lactate≥2 mmol/L; and 69% (95% CI60% to 77%) for NEWS≥7, 80% (95% CI72% to 86%) for LNEWS≥7, 87% (95% CI80% to 92%) for NEWS≥7 or lactate≥2 mmol/L.

Conclusion Lactate used in tandem with qSOFA or NEWS yielded higher sensitivities in predicting in-hospital 28-day mortality, as compared with integration of lactate into these prediction tools or usage of the tools independently.

  • infections
  • triage
  • death

Data availability statement

Data are available upon reasonable request. The datasets of this study are available upon reasonable request from the corresponding author.

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Data availability statement

Data are available upon reasonable request. The datasets of this study are available upon reasonable request from the corresponding author.

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Footnotes

  • Handling editor Roland C Merchant

  • Contributors JJ—collection, analysis and interpretation of data, and manuscript preparation. DD—analysis and interpretation of data, and critical revision of the manuscript. M-SM—collection, analysis and interpretation of data, and manuscript preparation. J-CC—study concept and design, analysis and interpretation of data, drafting the manuscript and manuscript preparation. J-CC is the guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.