Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Institute of Applied Health Research, College of Medical and Dental Sciences, Murray Learning Centre, University of Birmingham, Birmingham.
Br J Gen Pract. 2017 Dec;67(665):e859-e870. doi: 10.3399/bjgp17X693665. Epub 2017 Nov 20.
Lactate is measured in hospital settings to identify patients with sepsis and severe infections, and to guide initiation of early treatment. Point-of-care technology could facilitate measurement of lactate by clinicians in the community. However, there has been little research into its utility in these environments.
To investigate the effect of using point-of-care lactate at presentation to health care on mortality and other clinical outcomes, in patients presenting with acute infections.
Studies comparing the use of point-of-care lactate to usual care in initial patient assessment at presentation to health care were identified using a maximally sensitive search strategy of six electronic databases.
Two independent authors screened 3063 records for eligibility, and extracted data from eligible studies. Quality assessment for observational studies was performed using the ROBINS-I tool.
Eight studies were eligible for inclusion (3063 patients). Seven studies were recruited from emergency departments, and one from a pre-hospital aeromedical setting. Five studies demonstrated a trend towards reduced mortality with point-of-care lactate; three studies achieved statistical significance. One study demonstrated a significant reduction in length of hospital stay, although another did not find any significant difference. Two studies demonstrated a significant reduction in time to treatment for antibiotics and intravenous fluids.
This review identifies an evidence gap - there is no high-quality evidence to support the use of point-of-care lactate in community settings. There are no randomised controlled trials (RCTs) and no studies in primary care. RCT evidence from community settings is needed to evaluate this potentially beneficial diagnostic technology.
在医院环境中测量乳酸可用于识别患有败血症和严重感染的患者，并指导早期治疗的开始。即时检测技术可以使社区临床医生更方便地测量乳酸。然而，关于其在这些环境中的实用性的研究甚少。
调查在急性感染患者就诊时，即时检测乳酸在就诊时对医疗保健的影响死亡率和其他临床结果。
使用六项电子数据库的最大敏感搜索策略，确定了比较即时检测乳酸与常规护理在就诊时初始患者评估中使用的研究。
两名独立作者筛选了 3063 篇记录的资格，并从合格的研究中提取数据。使用 ROBINS-I 工具对观察性研究进行质量评估。
有 8 项研究符合纳入标准（3063 名患者）。7 项研究是从急诊科招募的，1 项是从院前航空医疗环境中招募的。五项研究表明，即时检测乳酸有降低死亡率的趋势；三项研究达到了统计学意义。一项研究表明，即时检测乳酸可显著缩短住院时间，尽管另一项研究没有发现任何显著差异。两项研究表明，即时检测乳酸可显著缩短抗生素和静脉输液的治疗时间。
本综述确定了一个证据空白——没有高质量的证据支持在社区环境中使用即时检测乳酸。没有随机对照试验（RCT），也没有初级保健研究。需要来自社区环境的 RCT 证据来评估这种潜在有益的诊断技术。
