Emergency Department, Lausanne University Hospital, University of Lausanne, 1011, Lausanne, Switzerland.
Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Intern Emerg Med. 2022 Sep;17(6):1803-1812. doi: 10.1007/s11739-022-03005-w. Epub 2022 Jun 9.
Patients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing (POCT) in this population. The secondary objective was to assess the additional value of lactate level in predicting an early poor outcome, as compared to and combined with common clinical scores and triage scales.
This monocentric prospective study recruited ED patients who were over 65 years old between July 19th 2019 and June 17th 2020. Patients consulting for seizures or needing immediate assessment were excluded. POCT lactates were considered elevated if ≥ 2.5 mmol/L. A poor outcome was defined based on certain complications or therapeutic decisions.
In total, 602 patients were included; 163 (27.1%) had elevated lactate and 44 (7.3%) had a poor outcome. There was no association between poor outcome and lactate level. Modified Early Warning Score (MEWS) was significantly associated with poor outcome, alongside National Early Warning Score (NEWS). Logistic regression also associated lactate level combined with MEWS and poor outcome.
The prevalence of elevated lactate was 27.1%. Lactate level alone or combined with different triage scales or clinical scores such as MEWS, NEWS and qSOFA was not associated with prediction of a poor outcome. MEWS alone performed best in predicting poor outcome. The usefulness of POCT lactate measurement at triage is questionable in the population of 65 and above.
65 岁以上的患者占急诊科（ED）入院人数的 24%。由于生理反应受损，他们的分诊风险增加。本研究的主要目的是评估该人群中即时护理检测（POCT）升高的乳酸的患病率。次要目的是评估与常见临床评分和分诊量表相比，乳酸水平在预测早期不良结局方面的附加价值。
这是一项单中心前瞻性研究，招募了 2019 年 7 月 19 日至 2020 年 6 月 17 日期间 65 岁以上的 ED 患者。排除因癫痫发作或需要立即评估而就诊的患者。如果 POCT 乳酸值≥2.5mmol/L，则认为乳酸升高。根据某些并发症或治疗决策定义不良结局。
共纳入 602 例患者；163 例（27.1%）乳酸升高，44 例（7.3%）不良结局。不良结局与乳酸水平之间没有关联。改良早期预警评分（MEWS）与不良结局显著相关，与国家早期预警评分（NEWS）一致。逻辑回归也将乳酸水平与 MEWS 结合与不良结局相关联。
升高的乳酸患病率为 27.1%。单独的乳酸水平或与不同的分诊量表或临床评分（如 MEWS、NEWS 和 qSOFA）结合使用与不良结局的预测无关。MEWS 单独预测不良结局的效果最佳。在 65 岁及以上人群中，POCT 乳酸测量在分诊中的有用性值得怀疑。
