Journal article
Serum anion gap predicts lactate poorly, but may be used to identify sepsis patients at risk for death: A cohort study
Journal of critical care, Vol.44, pp.223-228
04/2018
DOI: 10.1016/j.jcrc.2017.10.043
PMID: 29175046
Abstract
(1) To test whether serum bicarbonate or anion gap can be used to predict elevated lactate or mortality in emergency department (ED) patients with sepsis, and (2) to define thresholds that may predict elevated lactate and mortality.
Retrospective diagnostic-validation study of adults with sepsis treated in a 60,000-visit Midwestern university ED (2010–2015). In the derivation sample, 8 experts selected thresholds based on objective measures to optimize clinical utility. Test performance was reported using likelihood ratios (LR +/−) in the validation cohort.
We included 4159 patients. Anion gap predicted lactate>2 better than bicarbonate [ROC AUC 0.680 vs. 0.609], and anion gap predicted lactate>4 better than lactate>2 [ROC AUC 0.816 vs. 0.680]. In the validation cohort, anion gap ≥20mEq/L had LR+ for lactate>2 of 3.670 (2.630–5.122), lactate>4 of 7.019 (5.310–9.278), and mortality of 2.768 (1.922–3.986). Anion gap predicted mortality similar to lactate>2 [LR+ 2.768 vs. LR+ 2.09; LR− 0.823 vs. 0.447].
Anion gap and serum bicarbonate poorly predict changes in lactate and mortality. In resource-limited settings where lactate is unavailable, anion gap ≥20mEq/L may be used to further risk-stratify patients for ongoing sepsis care, but lactate remains a preferred biomarker.
•Serum bicarbonate or anion gap is proposed to predict elevated lactate or mortality in patients with suspected sepsis•Anion gap and serum bicarbonate poorly predict changes in lactate and mortality•Anion gap may be used to further risk-stratify patients for ongoing sepsis care, but lactate remains a preferred biomarker.
Details
- Title: Subtitle
- Serum anion gap predicts lactate poorly, but may be used to identify sepsis patients at risk for death: A cohort study
- Creators
- Nicholas M Mohr - Department of Emergency Medicine, University of Iowa College of Medicine, Iowa City, IA, United StatesJ. Priyanka Vakkalanka - Department of Emergency Medicine, University of Iowa College of Medicine, Iowa City, IA, United StatesBrett A Faine - Department of Emergency Medicine, University of Iowa College of Medicine, Iowa City, IA, United StatesBrian Skow - Avera eCARE, Sioux Falls, SD, United StatesKarisa K Harland - Department of Emergency Medicine, University of Iowa College of Medicine, Iowa City, IA, United StatesRyan Dick-Perez - Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, United StatesBrian M Fuller - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington University School of Medicine, St. Louis, MO, United StatesAzeemuddin Ahmed - Department of Emergency Medicine, University of Iowa College of Medicine, Iowa City, IA, United StatesSteven Q Simson - Division of Pulmonary Disease and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS, United States
- Resource Type
- Journal article
- Publication Details
- Journal of critical care, Vol.44, pp.223-228
- DOI
- 10.1016/j.jcrc.2017.10.043
- PMID
- 29175046
- NLM abbreviation
- J Crit Care
- ISSN
- 0883-9441
- eISSN
- 1557-8615
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 04/2018
- Academic Unit
- Rural Telehealth Research Center; Management and Entrepreneurship ; Epidemiology; Emergency Medicine; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Law Faculty
- Record Identifier
- 9984024550502771
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