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The following is a summary of “Prehospital lactate analysis in suspected sepsis improves detection of patients with increased mortality risk: an observational study,” published in the January 2025 issue of Critical Care by Andersson et al. 

Timely and effective treatment is vital to reduce sepsis mortality, but emergency departments (ED) risk stratification scores often fail to identify all sepsis cases with elevated mortality risk.  

Researchers conducted a retrospective study to evaluate whether adding prehospital lactate analysis to clinical risk stratification tools enhanced the detection of patients with sepsis at increased risk for rapid deterioration and death.  

They assessed adult patients with suspected sepsis over 10 months, measuring prehospital lactate as both a continuous variable and in intervals. Subgroup analyses were performed based on priority levels from the Rapid Emergency Triage and Treatment System (RETTS) and National Early Warning Score 2 (NEWS2). The primary outcome was 30-day mortality, while secondary outcomes included sepsis at the ED and in-hospital mortality.  

The results showed 714 patients with a 30-day mortality rate of 10%. Among 322 cases (45%) meeting Sepsis-3 criteria, the 30-day mortality was 14%. Non-survivors had higher prehospital lactate levels (2.6 vs 2.0 mmol/L, P < 0.001). Mortality rates by lactate intervals were 6.7% at 0–2 mmol/L, 10.0% at >2–3 mmol/L, 19.2% at >3–4 mmol/L, and 17.0% at >4 mmol/L. The highest priority (red) RETTS group had higher lactate levels than the lower priority group (2.5 vs 1.9 mmol/L, P < 0.001). Among non-red group non-survivors, lactate levels were higher (2.4 vs 1.8 mmol/L, P = 0.002). Multivariable regression showed that prehospital lactate >3 mmol/L was a predictor of 30-day mortality (OR 2.20, P = 0.009), with a stronger association in the non-red RETTS group (OR 3.02, P = 0.009). Adding prehospital lactate >3 mmol/L improved non-survivor identification from 48% to 68% in the RETTS red group and from 77% to 85% in the NEWS2 ≥7 group.  

Investigators concluded that adding prehospital lactate levels to risk stratification scores improved early identification of the patients with sepsis with increased mortality risk, especially those not initially flagged as severely ill. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05225-2