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|Title: ||Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1–infected patient population in Uganda|
|Authors: ||Moore, Christopher C.|
Jacob, Shevin T.
Meya, David B.
Reynolds, Steven J.
Scheld, Michael W.
HIV Type 1–Infected
|Issue Date: ||2008 |
|Publisher: ||Infectious Diseases Society of America|
|Citation: ||Moore, C., e tal (2008). Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1–infected patient population in Uganda. Clinical Infectious Diseases, 46:215–22|
|Abstract: ||Background: Prediction of mortality may improve management and outcomes of patients with sepsis in resource-limited settings. Therefore, we evaluated the ability of a hand-held portable whole-blood lactate (PWBL)
analyzer to predict mortality of patients who are admitted to the hospital with severe sepsis.
Methods: A prospective observational study enrolled 253 patients at a national referral hospital in Uganda.
Inclusion criteria required (1) ≥2 systemic inflammatory response syndrome criteria or thermodysregulation, (2) hypotension, and (3) suspected infection. A subset of 72 patients had PWBL and standard laboratory serum lactate
measured. The primary measured outcome was in-hospital mortality.
Results: Fifty-nine (81.9%) of 72 evaluated patients were infected with human immunodeficiency virus type
1. The in-hospital mortality rate was 25.7% (18 of 70), and the in- and outpatient mortality at 30 days was 41.6%
(30 of 72). PWBL was positively associated with in-hospital but not outpatient mortality (P <.001 ). The receiver
operating characteristic area under the curve for PWBL was 0.81 (P < .001). The optimal PWBL concentration for
predicting in-hospital mortality (sensitivity, 88.3%; specificity, 71.2%) was ≥4.0 mmol/L. Patients with a PWBL
concentration ≥4.0 mmol/L died while in the hospital substantially more often (50.0%) than did those with a PWBL concentration <4.0 mmol/L (7.5%) (odds ratio, 12.3; 95% confidence interval, 3.5–48.9; P <.001). Standard
laboratory serum lactate results were inconsistent and less predictive of mortality than were those of PWBL in a
multiple logistic regression model.
Conclusion: A PWBL concentration ≥4.0 mmol/L predicts with 81% accuracy a 7-fold higher mortality of
patients with sepsis than does a PWBL concentration <4.0 mmol/L. PWBL testing would be useful in places where clinical decisions are limited by lack of laboratory infrastructure and poor reliability.|
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