Prognosis of emergency department patients with suspected infection and intermediate lactate levels: a systematic review.

PURPOSE: Previous studies have shown a correlation between blood lactate greater than 4.0 mmol/L and mortality in patients with suspected infection in the emergency department (ED), but data are more limited regarding the prognosis of intermediate blood lactate (2.0-3.9 mmol/L), particularly in the absence of hemodynamic instability. We sought to quantify the prognostic significance of intermediate blood lactate levels in ED patients with suspected infection, emphasizing patients without hypotension.

METHODS: A systematic review of 4 databases was conducted to identify studies using a comprehensive search strategy. All studies performed on adult ED patients with suspected infection and available data on hemodynamics, intermediate lactate levels, and mortality rates were included.

RESULTS: We identified 20 potential publications, 8 of which were included. Intermediate lactate elevation was found in 11,062 patients with suspected or confirmed infection, 1672 (15.1%) of whom died. Subgroup analysis of normotensive patients demonstrated a mortality of 1561 (14.9%) of 10,442, with rates from individual studies between 3.2% and 16.4%.

CONCLUSION: This systematic review found that among ED patients with suspected infection, intermediate lactate elevation is associated with a moderate to high risk of mortality, even among patients without hypotension. Physicians should consider close monitoring and aggressive treatment for such patients.