Abstract
Objectives
Blood gas analysis, including parameters like lactate and base excess (BE), is crucial in emergency medicine but less commonly utilized prehospital. This study aims to elucidate the relationship between lactate and BE in various emergencies in a prehospital setting and their prognostic implications.
Methods
We conducted a retrospective analysis of prehospital emergency patients in Graz, Austria, from October 2015 to November 2020. Our primary aim was to assess the association between BE and lactate. This was assessed using Spearman’s rank correlation and fitting a multiple linear regression model with lactate as the outcome, BE as the primary covariate of interest and age, sex, and medical emergency type as confounders.
Results
In our analysis population (n=312), lactate and BE levels were inversely correlated (Spearman’s ρ, −0.75; p<0.001). From the adjusted multiple linear regression model (n=302), we estimated that a 1 mEq/L increase in BE levels was associated with an average change of −0.35 (95 % CI: −0.39, −0.30; p<0.001) mmol/L in lactate levels. Lactate levels were moderately useful for predicting mortality with notable variations across different emergency types.
Conclusions
Our study highlights a significant inverse association between lactate levels and BE in the prehospital setting, underscoring their importance in early assessment and prognosis in emergency care. Additionally, the findings from our secondary aims emphasize the value of lactate in diagnosing acid–base disorders and predicting patient outcomes. Recognizing the nuances in lactate physiology is essential for effective prehospital care in various emergency scenarios.
-
Research ethics: The local Institutional Review Board reviewed the study protocol and approved it (33-317 ex20/21, Ethics committee of the Medical University Graz, Austria).
-
Informed consent: Not applicable.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: The authors state no conflict of interest.
-
Research funding: None declared.
References
1. Zwisler, ST, Zincuk, Y, Bering, CB, Zincuk, A, Nybo, M, Mikkelsen, S. Diagnostic value of prehospital arterial blood gas measurements - a randomised controlled trial. Scand J Trauma Resusc Emerg Med 2019;27:1–9. https://doi.org/10.1186/s13049-019-0612-8.Search in Google Scholar PubMed PubMed Central
2. Wardi, G, Brice, J, Correia, M, Liu, D, Self, M, Tainter, C. Demystifying lactate in the emergency department. Ann Emerg Med [Internet] 2020;75:287–98. https://doi.org/10.1016/j.annemergmed.2019.06.027.Search in Google Scholar PubMed
3. Kruse, O, Grunnet, N, Barfod, C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med 2011;19:5–8. https://doi.org/10.1186/1757-7241-19-74.Search in Google Scholar PubMed PubMed Central
4. Kraut, JA, Madias, NE. Lactic acidosis. N Engl J Med, 2014 371:2309–19.10.1056/NEJMra1309483Search in Google Scholar PubMed
5. Garcia-alvarez, M, Marik, P, Bellomo, R. Sepsis-associated hyperlactatemia. Crit Care 2014;18:503. https://doi.org/10.1186/s13054-014-0503-3.Search in Google Scholar PubMed PubMed Central
6. Brooks, GA. Lactate as a fulcrum of metabolism. Redox Biol 2020;35:101454. https://doi.org/10.1016/j.redox.2020.101454.Search in Google Scholar PubMed PubMed Central
7. Gladden, LB. Lactate metabolism: a new paradigm for the third millennium. J Physiol 2004;558:5–30. https://doi.org/10.1113/jphysiol.2003.058701.Search in Google Scholar PubMed PubMed Central
8. Lee, TY. Lactate: a multifunctional signaling molecule. Yeungnam Univ J Med 2021;38:183–93.10.12701/yujm.2020.00892Search in Google Scholar PubMed PubMed Central
9. Baxter, J, Cranfield, KR, Clark, G, Harris, T, Bloom, B, Gray, AJ. Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review. J Trauma Acute Care Surg 2016;81:555–66. https://doi.org/10.1097/ta.0000000000001156.Search in Google Scholar
10. Bhat, SR, Swenson, KE, Francis, MW, Wira, CR. Lactate clearance predicts survival among patients in the emergency department with severe sepsis. West J Emerg Med 2015;16:1118–26. https://doi.org/10.5811/westjem.2015.10.27577.Search in Google Scholar PubMed PubMed Central
11. Van Beest, PA, Mulder, PJ, Oetomo, SB, Van Den Broek, B, Kuiper, MA, Spronk, PE. Measurement of lactate in a prehospital setting is related to outcome. Eur J Emerg Med 2009;16:318–22. https://doi.org/10.1097/mej.0b013e32832dbe54.Search in Google Scholar PubMed
12. Siggaard-Andersen, O, Fogh-Andersen, N. Base excess or buffer base (strong ion difference) as measure of a non-respiratory acid–base disturbance. Acta Anaesthesiol Scand 1995;39:123–8. https://doi.org/10.1111/j.1399-6576.1995.tb04346.x.Search in Google Scholar PubMed
13. Husain, FA, Martin, MJ, Mullenix, PS, Steele, SR, Elliott, DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg 2003;185:485–91. https://doi.org/10.1016/s0002-9610(03)00044-8.Search in Google Scholar PubMed
14. Zhang, Z, Xu, X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically Ill patients: a systematic review and meta-analysis. Crit Care Med 2014;42:2118–25. https://doi.org/10.1097/ccm.0000000000000405.Search in Google Scholar PubMed
15. Davis, JW, Dirks, RC, Kaups, KL, Tran, P. Base deficit is superior to lactate in trauma. Am J Surg 2018;215:682–5. https://doi.org/10.1016/j.amjsurg.2018.01.025.Search in Google Scholar PubMed
16. Raux, M, Le Manach, Y, Gauss, T, Baumgarten, R, Hamada, S, Harrois, A, et al.. Comparison of the prognostic significance of initial blood lactate and base deficit in trauma patients. Anesthesiology 2017;126:522–33. https://doi.org/10.1097/aln.0000000000001490.Search in Google Scholar PubMed
17. von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC, Vandenbroucke, JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008;61:344–9. https://doi.org/10.1016/j.jclinepi.2007.11.008.Search in Google Scholar PubMed
18. Schwartz, WB, Relman, AS. A critique of the parameters used in the evaluation of acid–base disorders. N Engl J Med 1963;268:1382–8. https://doi.org/10.1056/nejm196306202682503.Search in Google Scholar PubMed
19. R Core Team. R. A language and environment for statistical computing. [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2020 [cited 2022 Aug 4]. Available from: https://www.R-project.org/.Search in Google Scholar
20. Robergs, RA, Ghiasvand, F, Parker, D. Biochemistry of exercise-induced metabolic acidosis. Am J Physiol Regul Integr Comp Physiol 2004;287:502–16. https://doi.org/10.1152/ajpregu.00114.2004.Search in Google Scholar PubMed
21. Bellomo, R, Kellum, JA, Pinsky, MR. Transvisceral lactate fluxes during early endotoxemia. Chest 1996;110:198–204. https://doi.org/10.1378/chest.110.1.198.Search in Google Scholar PubMed
22. Momiyama, Y, Yamada, W, Miyata, K, Miura, K, Fukuda, T, Fuse, J, et al.. Prognostic values of blood pH and lactate levels in patients resuscitated from out-of-hospital cardiac arrest. Acute Med Surg 2017;4:25–30. https://doi.org/10.1002/ams2.217.Search in Google Scholar PubMed PubMed Central
23. Williams, TA, Martin, R, Celenza, A, Bremner, A, Fatovich, D, Krause, J, et al.. Use of serum lactate levels to predict survival for patients with out-of-hospital cardiac arrest: a cohort study. Emerg Med Australasia 2016;28:171–8. https://doi.org/10.1111/1742-6723.12560.Search in Google Scholar PubMed
24. Laurikkala, J, Skrifvars, MB, Bäcklund, M, Tiainen, M, Bendel, S, Karhu, J, et al.. Early lactate values after out-of-hospital cardiac arrest: associations with one-year outcome. Shock 2019;51:168–73. https://doi.org/10.1097/shk.0000000000001145.Search in Google Scholar
25. Prause, G, Ratzenhofer-Comenda, B, Smolle-Jüttner, F, Heydar-Fadai, J, Wildner, G, Spernbauer, P, et al.. Comparison of lactate or BE during out-of-hospital cardiac arrest to determine metabolic acidosis. Resuscitation 2001;51:297–300. https://doi.org/10.1016/s0300-9572(01)00424-5.Search in Google Scholar PubMed
26. Park, M, Sidebotham, D. Metabolic alkalosis and mixed acid-base disturbance in anaesthesia and critical care. BJA Educ 2023;23:128–35. https://doi.org/10.1016/j.bjae.2023.01.002.Search in Google Scholar PubMed PubMed Central
27. Lentz, SA, Ackil, D. Metabolic acid–base disorders. Emerg Med Clin North Am 2023;41:849–62. https://doi.org/10.1016/j.emc.2023.06.008.Search in Google Scholar PubMed
28. Lewis, LM, Ferguson, I, House, SL, Aubuchon, K, Schneider, J, Johnson, K, et al.. Albuterol administration is commonly associated with increases in serum lactate in patients with asthma treated for acute exacerbation of asthma. Chest 2014;145:53–9. https://doi.org/10.1378/chest.13-0930.Search in Google Scholar PubMed
29. Doğan, EA, Ünal, A, Ünal, A, Erdoğan, Ç. Clinical utility of serum lactate levels for differential diagnosis of generalized tonic–clonic seizures from psychogenic nonepileptic seizures and syncope. Epilepsy Behav 2017;75:13–7. https://doi.org/10.1016/j.yebeh.2017.07.003.Search in Google Scholar PubMed
30. Matz, O, Zdebik, C, Zechbauer, S, Bündgens, L, Litmathe, J, Willmes, K, et al.. Lactate as a diagnostic marker in transient loss of consciousness. Seizure 2016;40:71–5. https://doi.org/10.1016/j.seizure.2016.06.014.Search in Google Scholar PubMed
31. Evans, L, Rhodes, A, Alhazzani, W, Antonelli, M, Coopersmith, CM, French, C, et al.. Surviving sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med 2021;49:e1063–143. https://doi.org/10.1097/ccm.0000000000005337.Search in Google Scholar PubMed
32. Vincent, JL, Bakker, J. Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care 2021;27:298–302. https://doi.org/10.1097/mcc.0000000000000824.Search in Google Scholar
33. Lewis, CT, Naumann, DN, Crombie, N, Midwinter, MJ. Prehospital point-of-care lactate following trauma: a systematic review. J Trauma Acute Care Surg 2016;81:748–55. https://doi.org/10.1097/ta.0000000000001192.Search in Google Scholar
Supplementary Material
This article contains supplementary material (https://doi.org/10.1515/cclm-2024-0060).
© 2024 Walter de Gruyter GmbH, Berlin/Boston
