• Eur J Emerg Med · Dec 2024

    Association between lactate determined at emergency department arrival and the probability of inhospital mortality and intensive care admission in elderly patients.

    • Aitor Alquézar-Arbé, Sergio Pérez-Baena, Cesáreo Fernández, Sira Aguiló, Guillermo Burillo, Javier Jacob, Pere Llorens, Jesús Santianes Patiño, Paula Queizán García, Diana Rosendo Mesino, Osvaldo Jorge Troiano Ungerer, Aarati Vaswani-Bulchand, Montserrat Rodríguez-Cabrera, Mabel Coromoto Suárez Pineda, Patricia Gantes Nieto, Francesc Xavier Alemany González, Ana Puche Alcaraz, Bóveda GarcíaMaríaMEmergency Department, Hospital Universitario y Politécnico La Fe, Valencia., Mónica Veguillas Benito, Francisco Chamorro, Coral Suero Méndez, Eva Fragero Blesa, Rodrigo Javier Gil Hernández, Paula Pedraza Ramírez, Juan González Del Castillo, Òscar Miró, and (on behalf of the SIESTA Network).
    • Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona.
    • Eur J Emerg Med. 2024 Dec 11.

    Background And ImportanceElderly patients often have atypical clinical presentations. Lactate measurement on arrival at the Emergency Department (ED) could be useful to identify elderly patients with a bad prognosis.ObjectiveThe study aimed to investigate the relationship between serum lactate determined at ED arrival and the probability of inhospital mortality and intensive care (ICU) admission in elderly patients.DesignRetrospective multipurpose registry. Secondary analysis of the EDEN cohort (Elderly Department and Elder Needs).Settings And ParticipantsAll patients ≥65 years attending 52 Spanish EDs during 2 week and in whom serum lactate was determined at ED arrival.Outcome Measures And AnalysisThe relationship between serum lactate values and the risk of inhospital all-cause death and transfer from the ED to the ICU was assessed by unadjusted and adjusted logistic regression assuming linearity and restricted cubic spline models assuming nonlinearity.ResultsThe cohort included 25 557 patients. The 3024 patients in whom lactate was measured were analyzed. The median age was 81 years (74-87), 1506 (27.2%) were women, 591 (19.5%) had serious comorbidities, 475 (15.7%) severe dependency, and 648 (21.4%) dementia. Death occurred during hospitalization in 217 patients (7.2%) and 53 patients (1.75%) were admitted to the ICU. Serum lactate values were nonlinear related to inhospital mortality and ICU admission. Serum lactate >3.1 mmol/L [odds ratio (OR): 1.60, 95% confidence interval (CI): 1.02-2.50] for inhospital mortality and 3.2 mmol/L (OR: 2.83, 95% CI: 1.03-6.79) for ICU admission were associated with significantly increased ORs in the adjusted models.ConclusionSerum lactate measured at ED arrival has a significant and exponential relationship with inhospital mortality and ICU admission in elderly patients.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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