The utility of point of care serum lactate in predicting serious adverse outcomes among critically ill adult patients at urban emergency departments of tertiary hospitals in Tanzania
Abstract Background Elevated serum lactate levels have been shown in numerous studies to be associated with serious adverse events, including mortality. Point of care lactate level is increasingly available in resource-limited emergency department (ED) settings. However, little is known about the pr...
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ftdoajarticles:oai:doaj.org/article:f74347cb05c24e19ac2835ad6959d16c 2023-05-15T15:17:58+02:00 The utility of point of care serum lactate in predicting serious adverse outcomes among critically ill adult patients at urban emergency departments of tertiary hospitals in Tanzania Uwezo Edward Hendry R. Sawe Juma A. Mfinanga Theresia A. Ottaru Michael Kiremeji Deus N. Kitapondya Dereck A. Kaale Asha Iyullu Nicks Bret Ellen J. Weber 2019-12-01T00:00:00Z https://doi.org/10.1186/s41182-019-0186-1 https://doaj.org/article/f74347cb05c24e19ac2835ad6959d16c EN eng BMC https://doi.org/10.1186/s41182-019-0186-1 https://doaj.org/toc/1349-4147 doi:10.1186/s41182-019-0186-1 1349-4147 https://doaj.org/article/f74347cb05c24e19ac2835ad6959d16c Tropical Medicine and Health, Vol 47, Iss 1, Pp 1-13 (2019) Lactate level Serious adverse outcomes Emergency medicine Emergency care Tanzania Arctic medicine. Tropical medicine RC955-962 article 2019 ftdoajarticles https://doi.org/10.1186/s41182-019-0186-1 2022-12-31T06:22:55Z Abstract Background Elevated serum lactate levels have been shown in numerous studies to be associated with serious adverse events, including mortality. Point of care lactate level is increasingly available in resource-limited emergency department (ED) settings. However, little is known about the predictive ability of for serious adverse events. Aim of the study We aimed to describe the utility of serum lactate level as a predictor of 24-h serious adverse events among adult patients presenting at the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH) and MUHAS Academic Medical Center (MAMC). Methods This was a prospective observational study involving adult patients presenting to the EMD-MNH and MAMC from 1 September 2018 and 31 October 2018. Eligible patients with at least one lactate level test drawn while in the ED were examined in terms of their demographics, relevant clinical characteristics, and any serious adverse event (SAE) within 24 h of arrival. The sensitivity and specificity of lactate level to predict outcomes of interest were determined using the best cut-off point constructed from AUROC to see how well lactate level could discriminate which patients would have adverse events in the next 24 h. Categorical and continuous variables were compared with the chi-square test and two-sample t test, respectively. Results We screened 2057 (20.9%) out of 9828 patients who presented during study period, and enrolled 387 (18.8%). The overall median age was 54 years (interquartile range 40–68 years) and 206 (53.2%) were male. Using local triaging system, a total of 322 (83.2%) was triaged as an emergency category. The mean lactate level was 3.2 ± 3.6 mmol/L, 65 (16.8%) patients developed at least one SAE, with 42 (11%) who required ICU/HDU, 37 (10%) needed ventilator support, 10 (3%) required inotropes, and 9 (2%) developed cardiac arrest. The overall 24-h mortality was 28 (7%). The AUC of serum lactate level for overall 24-h mortality was 0.801 (95%CI, 0.7–0.9, P ≤ 0.001). At the optimal ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Tropical Medicine and Health 47 1 |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Lactate level Serious adverse outcomes Emergency medicine Emergency care Tanzania Arctic medicine. Tropical medicine RC955-962 |
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Lactate level Serious adverse outcomes Emergency medicine Emergency care Tanzania Arctic medicine. Tropical medicine RC955-962 Uwezo Edward Hendry R. Sawe Juma A. Mfinanga Theresia A. Ottaru Michael Kiremeji Deus N. Kitapondya Dereck A. Kaale Asha Iyullu Nicks Bret Ellen J. Weber The utility of point of care serum lactate in predicting serious adverse outcomes among critically ill adult patients at urban emergency departments of tertiary hospitals in Tanzania |
topic_facet |
Lactate level Serious adverse outcomes Emergency medicine Emergency care Tanzania Arctic medicine. Tropical medicine RC955-962 |
description |
Abstract Background Elevated serum lactate levels have been shown in numerous studies to be associated with serious adverse events, including mortality. Point of care lactate level is increasingly available in resource-limited emergency department (ED) settings. However, little is known about the predictive ability of for serious adverse events. Aim of the study We aimed to describe the utility of serum lactate level as a predictor of 24-h serious adverse events among adult patients presenting at the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH) and MUHAS Academic Medical Center (MAMC). Methods This was a prospective observational study involving adult patients presenting to the EMD-MNH and MAMC from 1 September 2018 and 31 October 2018. Eligible patients with at least one lactate level test drawn while in the ED were examined in terms of their demographics, relevant clinical characteristics, and any serious adverse event (SAE) within 24 h of arrival. The sensitivity and specificity of lactate level to predict outcomes of interest were determined using the best cut-off point constructed from AUROC to see how well lactate level could discriminate which patients would have adverse events in the next 24 h. Categorical and continuous variables were compared with the chi-square test and two-sample t test, respectively. Results We screened 2057 (20.9%) out of 9828 patients who presented during study period, and enrolled 387 (18.8%). The overall median age was 54 years (interquartile range 40–68 years) and 206 (53.2%) were male. Using local triaging system, a total of 322 (83.2%) was triaged as an emergency category. The mean lactate level was 3.2 ± 3.6 mmol/L, 65 (16.8%) patients developed at least one SAE, with 42 (11%) who required ICU/HDU, 37 (10%) needed ventilator support, 10 (3%) required inotropes, and 9 (2%) developed cardiac arrest. The overall 24-h mortality was 28 (7%). The AUC of serum lactate level for overall 24-h mortality was 0.801 (95%CI, 0.7–0.9, P ≤ 0.001). At the optimal ... |
format |
Article in Journal/Newspaper |
author |
Uwezo Edward Hendry R. Sawe Juma A. Mfinanga Theresia A. Ottaru Michael Kiremeji Deus N. Kitapondya Dereck A. Kaale Asha Iyullu Nicks Bret Ellen J. Weber |
author_facet |
Uwezo Edward Hendry R. Sawe Juma A. Mfinanga Theresia A. Ottaru Michael Kiremeji Deus N. Kitapondya Dereck A. Kaale Asha Iyullu Nicks Bret Ellen J. Weber |
author_sort |
Uwezo Edward |
title |
The utility of point of care serum lactate in predicting serious adverse outcomes among critically ill adult patients at urban emergency departments of tertiary hospitals in Tanzania |
title_short |
The utility of point of care serum lactate in predicting serious adverse outcomes among critically ill adult patients at urban emergency departments of tertiary hospitals in Tanzania |
title_full |
The utility of point of care serum lactate in predicting serious adverse outcomes among critically ill adult patients at urban emergency departments of tertiary hospitals in Tanzania |
title_fullStr |
The utility of point of care serum lactate in predicting serious adverse outcomes among critically ill adult patients at urban emergency departments of tertiary hospitals in Tanzania |
title_full_unstemmed |
The utility of point of care serum lactate in predicting serious adverse outcomes among critically ill adult patients at urban emergency departments of tertiary hospitals in Tanzania |
title_sort |
utility of point of care serum lactate in predicting serious adverse outcomes among critically ill adult patients at urban emergency departments of tertiary hospitals in tanzania |
publisher |
BMC |
publishDate |
2019 |
url |
https://doi.org/10.1186/s41182-019-0186-1 https://doaj.org/article/f74347cb05c24e19ac2835ad6959d16c |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Tropical Medicine and Health, Vol 47, Iss 1, Pp 1-13 (2019) |
op_relation |
https://doi.org/10.1186/s41182-019-0186-1 https://doaj.org/toc/1349-4147 doi:10.1186/s41182-019-0186-1 1349-4147 https://doaj.org/article/f74347cb05c24e19ac2835ad6959d16c |
op_doi |
https://doi.org/10.1186/s41182-019-0186-1 |
container_title |
Tropical Medicine and Health |
container_volume |
47 |
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1 |
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1766348216021811200 |