| Serum Lactate Is a Better Predictor of Short-Term Mortality When Stratified by C-reactive Protein in Adult Emergency Department Patients Hospitalized for a Suspected Infection. | |
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MedLine Citation:
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PMID: 21111512 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: We determine whether C-reactive protein (CRP) adds prognostic value to serum lactate levels when assessing mortality risk in emergency department (ED) patients admitted for a suspected infection. METHODS: This was an observational cohort of unique adult patients (≥21 years of age) who had lactate and CRP testing in the ED and were admitted for a suspected infection during a 1-year period. All data were collected through retrospective chart review. The study site is an urban teaching hospital with an approximate annual census of 95,000 patients. The endpoint was 28-day inpatient mortality. RESULTS: One thousand one hundred forty-three patients had lactate and CRP testing in the ED, an admitting diagnosis of infection, and complete records. Twenty-eight-day inpatient mortality for patients with both a lactate level greater than or equal to 4.0 mmol/L and CRP level greater than 10.0 mg/dL was 44.0% (95% confidence interval [CI] 32.5% to 55.5%), for lactate greater than or equal to 4.0 mmol/L and CRP less than or equal to 10.0 mg/dL, it was 9.7% (95% CI 2.7% to 16.7%), and for lactate level less than 4.0 mmol/L, it was 9.1% (95% CI 7.3% to 10.9%). In a logistic regression model that included patient demographics and Charlson score, as well as 4 separate dichotomous variables that were positive only in subjects with (1) serum lactate greater than or equal to 4.0 mmol/L and CRP level greater than 10.0 mg/dL, (2) lactate level greater than or equal to 4.0 mmol/L and CRP level less than or equal to 10.0 mg/dL, (3) lactate level less than 4.0 mmol/L and CRP level greater than 10.0 mg/dL, and (4) lactate level less than 4.0 mmol/L and CRP level less than or equal to 10.0 mg/dL (as reference), patients with both a lactate level greater than or equal to 4.0 mmol/L and CRP greater than 10 mg/dL had an increased risk of 28-day inpatient mortality (odds ratio 12.3; 95% CI 6.8 to 22.3). CONCLUSION: In this cohort, patients with both an increased CRP level and hyperlactatemia had a higher mortality rate than patients with abnormalities of either laboratory test in isolation. |
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Authors:
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Jeffrey P Green; Tony Berger; Nidhi Garg; Nathan I Shapiro |
Publication Detail:
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Type: Journal Article Date: 2010-12-15 |
Journal Detail:
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Title: Annals of emergency medicine Volume: 57 ISSN: 1097-6760 ISO Abbreviation: Ann Emerg Med Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-02-28 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8002646 Medline TA: Ann Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 291-5 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Emergency Medicine, New York Hospital Queens, Weill Cornell Medical College, Flushing, NY. |
Export Citation:
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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