Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low- to middle-income country

doi:10.5847/wjem.j.1920-8642.2017.03.004

Abstract

Abstract:

BACKGROUND: Timely identification of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care (POC) testing is being increasingly utilized in the emergency department (ED). We examined the accuracy and time-saving effect of a handheld POC lactate device for the measurement of fingertip and whole blood lactate as compared with reference laboratory blood testing in septic ED patients.

METHODS: A convenience sample of adult ED patients receiving serum lactate testing were enrolled prospectively in the ED of a multidisciplinary tertiary care hospital serving the population of one of the major cities of Pakistan. Participants underwent fingertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC lactate device and standard laboratory method. Lactate measurements were compared by intraclass correlation (ICC) and Bland and Altman plots.

RESULTS: Forty-three septic patients were included in the study. The fingertip POC & whole blood POC lactate measurements each correlated tightly with the reference method (ICC=0.93 & ICC=0.92, respectively). Similarly at 6 hours, the fingertip POC & whole blood POC lactate measurements demonstrated satisfactory correlation with the reference method (ICC=0.95 & ICC=0.97, respectively).

CONCLUSION: Fingertip POC lactate measurement is an accurate method to determine lactate levels in septic ED patients.

Key words: Sepsis, Point of care, Lactate, Emergency department, Pakistan

Muhammad Akbar Baig, Hira Shahzad, Erfan Hussain, Asad Mian. Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low- to middle-income country[J]. World Journal of Emergency Medicine, 2017, 8(3): 184-189.

Figures/Tables 5

Table 1

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Variables	Results
Age in years (mean±SD, range)	58.02±18.28, 18-92
18-35 years, n (%)	6 (14.0)
36-50 years, n (%)	7 (16.3)
51-65 years, n (%)	14 (32.6)
> 65 years, n (%)	16 (37.2)
Gender, n (%)
Male	35 (81.4)
Female	8 (18.6)
Sepsis-induced hypotension, n (%)	31 (72.1)
Lactate>4 mmol/L, n (%)	41 (95.3)
Urine output<0.5 mL/(kg?hour), n (%)	7 (16.3)
Severe sepsis with hypotension despite adequate hydration, n (%)	19 (44.2)
SOFA Score (mean±SD, range)	9.07±4.87, 2-18
0-4, n (%)	7 (16.3)
5-7, n (%)	12 (27.9)
8-11, n (%)	11 (25.6)
≥12, n (%)	13 (30.2)
Time for blood sampling for lactate analysis in minutes (mean± SD, range)	157±226, 5-964
Time to antibiotic administration in minutes (mean±SD, range)	112±161, 10-729
Time to steroid administration, n (%)
<8 hours	6 (14.0)
8-24 hours	5 (11.6)
>24 hours	6 (14.0)
Not given	26 (60.5)
Vasopressors used, n (%)	25 (58.1)
Mortality outcome at 24 hours of presentation to the ED, n (%)
Alive	37 (86.0)
Expired	6 (14.0)

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