Breaking News
December 19, 2018 - New $1.6 million NIH grant supports study on a gene vital to circadian rhythms
December 19, 2018 - Racial Disparities Seen Among Teens Undergoing Flu Vaccination
December 19, 2018 - To resolve inflammation, location matters
December 19, 2018 - Research identifies new therapeutic target for cancer treatment and tissue regeneration
December 19, 2018 - Energy costs, social isolation contribute to health risk of older adults in extreme weather
December 19, 2018 - Potential combination therapy against rare disease of the bone marrow could improve treatment
December 19, 2018 - Researchers aim to improve cognition, reverse weight gain in schizophrenia
December 19, 2018 - UC San Diego Health offers new DRG stimulation device for phantom limb pain
December 19, 2018 - Study examines relationship between growth restriction and risk of childhood mortality
December 19, 2018 - New study provides insights on increased risk of suicide in young patients visiting ED
December 19, 2018 - AHA: Thyroid Problems Linked to Worsening Heart Failure
December 19, 2018 - World-first coeliac disease vaccine enters Phase 2 trials
December 19, 2018 - RNA sequencing offers novel insights into the microbiome
December 19, 2018 - A promising, effective vaccine for common respiratory disease
December 19, 2018 - Protein may slow progression of emphysema, study finds
December 19, 2018 - Studying atrial fibrillation — and exploring new frontiers in precision health
December 19, 2018 - A New Way To Get College Students Through A Psychiatric Crisis — And Back To School
December 19, 2018 - Optum, UnitedHealthcare take action to help people affected by North Carolina winter storms
December 18, 2018 - Weight change in middle-aged, elderly Chinese Singaporeans related to increased risk of death
December 18, 2018 - Immune cells sacrifice themselves to protect us from invading bacteria
December 18, 2018 - Watching brain cells fire, with a twist of gravitational waves
December 18, 2018 - 2018 in Review
December 18, 2018 - Getting the Most Out of the CLARITY Technique
December 18, 2018 - NVF shoes provide a viable option for track and road racing
December 18, 2018 - CRISPR may restore effectiveness of chemotherapies used to treat lung cancer
December 18, 2018 - New app accurately measures and charts progression of skin wounds
December 18, 2018 - Persistent Discrimination ID’d Among Physician Mothers
December 18, 2018 - Cellphone technology developed to detect HIV
December 18, 2018 - A Stanford doctor hits the field with the 49ers — as their airway management physician
December 18, 2018 - The Rise of Anxiety Baking
December 18, 2018 - Just one night of sleep deprivation increases the urge to eat
December 18, 2018 - Study reveals mechanism behind failed remyelination in MS
December 18, 2018 - New genetic testing method increases the precision of biomarker analysis
December 18, 2018 - Simple technique to effectively treat underdiagnosed cause of debilitating chest pain
December 18, 2018 - Barbershop-based medical intervention can successfully lower blood pressure, new data shows
December 18, 2018 - Food labels have caused changes in consumers’ intake and industry’s use of key additives
December 18, 2018 - Sickest children could benefit from split liver transplants
December 18, 2018 - Scientists create patient-specific model to identify most effective treatment for appendix cancer
December 18, 2018 - ‘Little Foot’ endocast reveals a small brain combining ape-like and human-like features
December 18, 2018 - New therapy for childhood blindness shows ‘very promising’ results
December 18, 2018 - Researchers discover promising new compound against Buruli ulcer
December 18, 2018 - Study finds significant use of traditional, complementary and alternative medicines in Sub-Saharan Africa
December 18, 2018 - California Farm Implicated in Outbreak of E. coli Tied to Romaine Lettuce
December 18, 2018 - Mobile health has power to transform HIV/AIDS nursing
December 18, 2018 - Celiac Vaccine in Clinical Trials at Columbia
December 18, 2018 - Research into mental health first aid prompts practical guidance and resources for workplace
December 18, 2018 - Researcher conducts study to investigate peripheral blood markers of Alzheimer’s disease
December 18, 2018 - Researchers identify link between mucus in the small airways and pulmonary fibrosis
December 18, 2018 - EU Commission’s Health Policy Platform to host EKHA program on transplantation
December 18, 2018 - Survivors of childhood Hodgkin lymphoma have high risk of developing solid tumors
December 18, 2018 - Small changes to cafeteria design can get kids to eat healthier, new assessment tool finds
December 18, 2018 - From Machines to Cyclic Compounds
December 18, 2018 - New study reveals best assessment tools to establish delirium severity
December 18, 2018 - Rice University scientists develop synthetic protein switches to control electron flow
December 18, 2018 - Home-based pulmonary function monitoring for teens with Duchenne muscular dystrophy
December 18, 2018 - Researchers identify potential target for new breast cancer treatments
December 18, 2018 - National Biofilms Innovation Centre award grant to Neem Biotech for novel anti-biofilm drug development
December 18, 2018 - Artificial intelligence and the future of medicine
December 18, 2018 - Montana State doctoral student receives grant for her work to improve neuroscience tool
December 18, 2018 - Early postpartum initiation of opioids associated with persistent use
December 18, 2018 - Russian scientists identify molecular ‘switch’ that could be target for treatment of allergic asthma
December 18, 2018 - Surgeons make more mistakes in the operating room during stressful moments, shows study
December 18, 2018 - Immune cells explode themselves to inform about the danger of invading bacteria
December 18, 2018 - Malnutrition in children with Crohn’s disease linked with increased risk of surgical complications
December 18, 2018 - FDA Approves Motegrity (prucalopride) for Adults with Chronic Idiopathic Constipation (CIC)
December 18, 2018 - The long and short of CDK12
December 18, 2018 - Hologic’s Cynosure division introduces TempSure Surgical RF technology in North America
December 18, 2018 - CMR Surgical partners with Nicholson Center to launch U.S.-based training program for Versius
December 18, 2018 - Findings reinforce guidelines for cautious use of antipsychotics in younger populations
December 18, 2018 - Study finds new strains of hepatitis C virus in sub-Saharan Africa
December 18, 2018 - New battery-free, implantable device aids weight loss
December 18, 2018 - Parental alcohol use disorder associated with offspring marital outcomes
December 18, 2018 - Novel Breast Imaging Technique Might Cut Unnecessary Biopsies
December 18, 2018 - What can a snowflake teach us about how cancer spreads in the body?
December 18, 2018 - Management of nausea and vomiting in pregnancy costs the NHS more than previously thought
December 18, 2018 - Green leafy vegetables may reduce risk of developing liver steatosis
December 18, 2018 - Veganism linked to nutrient deficiencies and malnutrition if not planned correctly
December 18, 2018 - Coming Soon: A Tiny Robot You Swallow to Help You Stay Healthy
December 18, 2018 - Modified malaria drug proven effective at inhibiting Ebola
December 18, 2018 - Study finds epigenetic differences in the brains of individuals with schizophrenia
Delayed lactate measurements in sepsis patients increase risk of in-hospital death

Delayed lactate measurements in sepsis patients increase risk of in-hospital death

image_pdfDownload PDFimage_print

The rising incidence of sepsis, a leading cause of in-hospital death, has prompted the Centers for Medicare and Medicaid Services (CMS) to issue protocols known as care bundles to standardize and improve sepsis care. Because of a known association between elevated lactate levels and increased mortality, the guidelines mandate that lactate levels should be tested soon after the onset of sepsis. A new study in the journal CHEST® found that a significant proportion of patients with suspected sepsis do not have their lactates measured within the recommended timeframe. These patients experienced delayed antibiotic therapy and IV fluid administration, as well as increased risk of in-hospital death.

According to first author Xuan (Susan) Han, MD, Department of Medicine, University of Chicago, Chicago, IL, USA, “Sepsis continues to be a major public health problem in the US, one with persistently high mortality despite continued efforts to improve care. Our goal with this study was to better understand, on a more granular level, how sepsis bundles affect the patients we apply them to.”

The guidelines, issued in 2015 by the CMS, are SEP-1 (Severe Sepsis and Septic Shock Early Management Bundle). One of the recommendations is the measurement of serum lactate between six hours before and three hours after severe sepsis presentation, followed by a repeat within six hours of presentation if the initial lactate is elevated.

“Systematic early lactate measurements in patients presenting with sepsis would result in a significant increase in the number of lactates measured on patients but may be of benefit in identifying patients with elevated initial lactates who are at risk for poorer outcomes. Patients with early lactate measurements received earlier interventions such as antibiotic administration, which is known to improve mortality in sepsis,” explained Matthew M. Churpek, MD, MPH, PhD, of the Department of Medicine and Center for Healthcare Delivery, Science and Innovation at the University of Chicago, Chicago, IL, USA.

To see what was being done in actual clinical practice, researchers at the University of Chicago reviewed the records of close to 150,000 patients admitted to a single tertiary care academic hospital from November 2008 to January 2016. Information regarding each patient’s characteristics, vital signs, laboratory measurements, and medical therapy was analyzed. There was a particular focus on lactate measurements and levels.

They identified 5,762 admissions that met the three SEP-1 criteria for severe sepsis within a six-hour period. Of these, only 60 percent had an initial lactate drawn within the SEP-1 specified timeframe. Fourteen percent had their levels measured between three and 24 hours after the time of first suspicion of sepsis (“delayed lactates”), and more than one quarter had no lactate measurements at all.

Whether lactates were measured promptly varied with where the patient was being treated. Seventy-nine percent of patients treated in the emergency department had levels measured within the specified time period compared with 55 percent in the intensive care unit (ICU) but only 32 percent in hospital wards. “Our study demonstrates that a large number of patients become newly septic on the wards. This is an important population of patients in which to effectively and quickly identify and treat sepsis,” commented Dr. Churpek.

Mortality increased with higher initial lactate levels. For example, in the ICU, the mortality rate was 35 percent for patients with a normal initial lactate level compared with 62 percent for those with elevated lactate levels. Most troubling, in patients with elevated lactate levels at the first draw, each hour of delay was associated with a 2 percent increase in the odds of in-hospital death. Importantly, it took approximately twice as long for patients with delayed lactate measurements to receive antibiotics and more than three times as long for them to receive fluids when compared with patients who had lactates drawn within the SEP-1 window.

“The SEP-1 bundle is the most recent national effort at standardizing and improving sepsis care, but the evidence supporting its various measures is mixed or lacking. In addition, SEP-1 has been highly controversial. This study better characterized the patients affected by SEP-1, as well as the impact of one component of SEP-1, lactate measurement, on hospitalized patients. Systematic early lactate measurements when a patient presents with sepsis may thus be useful in prompting earlier, potentially life-saving interventions,” added Dr. Churpek.

Source:

https://www.elsevier.com/

Tagged with:

About author

Related Articles