Delays in measuring lactate levels in patients with initial abnormal lactate levels are associated with delayed antibiotic treatment and increases in mortality, according to new findings published in Chest.
Sepsis is a significant cause of morbidity and mortality, and the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) defines patients who meet specific criteria within a 6-hour period as having “severe sepsis.” In this study, the authors attempted to identify and characterize patients who met SEP-1 criteria for severe sepsis and to assess the frequency of serum lactate level testing and whether lactate levels were associated with increased rates of interventions.
A retrospective study was conducted and included all patients admitted to a single US institution during an 8-year period from November 2008 to January 2016. The authors used modified SEP-1 criteria to identify patients who met the study inclusion criteria, and time to lactate draw, antibiotic, and intravenous fluid administration were calculated. In-hospital mortality was then later assessed.
Lactate levels were drawn within the mandated window 32% of the time on the ward (n=505) while in the intensive care unit. Lactate was drawn according to protocol 55% of the time (n=818). In the emergency department (n=2,144), lactate was drawn according to protocol 79% of the time.
Patients who experienced a delay in lactate measurement had the highest rate of in-hospital mortality (29%) as well as increased time to receipt of antibiotics (median time, 3.9 vs 2.0 hours).
Those with initial lactate levels >2.0 mmol/L had an increase in the odds of death with hourly delay in lactate measurement (odds ratio, 1.02; 95% CI, 1.0003-1.05; P =.04).
“Systematic early lactate measurements when a patient presents with sepsis may thus be useful in prompting earlier, potentially life-saving interventions,” the study authors concluded.
Han X, Edelson DP, Snyder A, et al. Implications of Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Early Management Bundle and initial lactate measurement on the management of sepsis [published online May 19, 2018]. Chest. doi: 10.1016/j.chest.2018.03.025