Prognostic value of lactate in prehospital care as a predictor of early mortality

Published:November 19, 2018DOI:



      Prehospital Emergency Medical Services must attend to patients with complex physiopathological situations with little data and in the shortest possible time. The objective of this work was to study lactic acid values and their usefulness in the prehospital setting to help in clinical decision-making.

      Study design

      We conducted a longitudinal prospective, observational study on patients over 18 years of age who, after being evaluated by the Advanced Life Support Unit, were taken to the hospital between April and June 2018. We analyzed demographic variables, prehospital lactic acid values and early mortality (<30 days). The area under the curve of the receiver operating characteristic was calculated for the prehospital value of lactic acid.


      A total of 279 patients were included in our study. The median age was 68 years (interquartile range: 54–80 years). Overall 30-day mortality was 9% (25 patients). The area under the curve for lactic acid to predict overall mortality at 30 days of care was 0.82 (95% CI: 0.76–0.89). The lactate value with the best sensitivity and specificity overall was 4.25 mmol/L with a sensitivity of 84% (95% CI: 65.3–93.6) and specificity of 70% (95% CI: 65.0–76.1).


      The level of lactic acid can be a complementary tool in the field of prehospital emergencies that will guide us early in the detection of critical patients.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sion J.
        • Jaechol Y.
        • Jae B.L.
        • Youngho J.
        • Taeoh J.
        • Boyoung P.
        Predictive value of the National Early Warning Score–Lactate for mortality and the need for critical care among general emergency department patients.
        J Crit Care. 2016; 36: 60-68
        • Florkowski C.
        • Don-Wauchope A.
        • Gimenez N.
        • Rodriguez-Capote K.
        • Wils J.
        • Zemlin A.
        Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) – does it leverage any advantage in clinical decision making?.
        Crit Rev Clin Lab Sci. 2017; 54: 471-494
        • Park Y.J.
        • Kim D.H.
        • Kim S.C.
        • Kim T.Y.
        • Kang C.
        • Lee S.H.
        • et al.
        Serum lactate upon emergency department arrival as a predictor of 30-day in-hospital mortality in an unselected population.
        PLoS One. 2018; 13e0190519
        • van den Nouland D.P.A.
        • Brouwers M.C.G.J.
        • Stassen P.M.
        Prognostic value of plasma lactate levels in a retrospective cohort presenting at a university hospital emergency department.
        BMJ Open. 2017; 7e011450
        • Shin T.G.
        • Jo I.J.
        • Hwang S.Y.
        • Jeon K.
        • Suh G.Y.
        • Choe E.
        • et al.
        Comprehensive interpretation of central venous oxygen saturation and blood lactate levels during resuscitation of patients with severe sepsis and septic shock in the emergency department.
        Shock. 2016; 45: 4-9
        • Andersen L.W.
        • Mackenhauer J.
        • Roberts J.C.
        • Berg K.M.
        • Cocchi M.N.
        • Donnino M.W.
        Etiology and therapeutic approach to elevated lactate levels.
        Mayo Clin Proc. 2013; 88: 1127-1140
        • Rhodes A.
        • Evans L.E.
        • Alhazzani W.
        • Levy M.M.
        • Antonelli M.
        • Ferrer R.
        • et al.
        Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
        Intensive Care Med. 2017; 43: 304-377
        • Seymour C.W.
        • Gesten F.
        • Prescott H.C.
        • Friedrich M.E.
        • Iwashyna T.J.
        • Phillips G.S.
        • et al.
        Time to treatment and mortality during mandated emergency care for sepsis.
        N Engl J Med. 2017; 376: 2235-2244
        • Léguillier T.
        • Jouffroy R.
        • Boisson M.
        • Boussaroque A.
        • Chenevier-Gobeaux C.
        • Chaabouni T.
        • et al.
        Lactate POCT in mobile intensive care units for septic patients? A comparison of capillary blood method versus venous blood and plasma-based reference methods.
        Clin Biochem. 2018; 55: 9-14
        • Lewis C.T.
        • Naumann D.N.
        • Crombie N.
        • Midwinter M.J.
        Prehospital point-of-care lactate following trauma: a systematic review.
        J Trauma Acute Care Surg. 2016; 81: 748-755
        • Lee D.
        • Cho I.
        • Lee S.
        • Min Y.
        • Min J.
        • Kim S.
        Correlation between initial serum levels of lactate after return of spontaneous circulation and survival and neurological outcomes in patients who undergo therapeutic hypothermia after cardiac arrest.
        Resuscitation. 2015; 88: 143-149
        • Contenti J.
        • Corraze H.
        • Lemoël F.
        • Levraut J.
        Effectiveness of arterial, venous, and capillary blood lactate as a sepsis triage tool in ED patients.
        Am J Emerg Med. 2015; 33: 167-172
        • Cao J.
        • Edwards R.
        • Chairez J.
        • Devaraj S.
        Validation of capillary blood analysis and capillary testing mode on the epoc Point of Care system.
        Practical Laboratory Medicine. 2017; 9: 24-27
        • Brown J.B.
        • Lerner E.B.
        • Sperry J.L.
        • Billiar T.R.
        • Peitzman A.B.
        • Guyette F.X.
        Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level.
        J Trauma Acute Care Surg. 2016; 81: 445-452
        • Walchok J.G.
        • Pirrallo R.G.
        • Furmanek D.
        • Lutz M.
        • Shope C.
        • Giles B.
        • et al.
        Paramedic-initiated CMS Sepsis Core measure bundle prior to hospital arrival: a stepwise approach.
        Prehosp Emerg Care. 2017; 21: 291-300
        • Williams T.A.
        • 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 Australas. 2016; 28: 171-178
        • 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: 2118-2125
        • Dezman Z.D.W.
        • Comer A.C.
        • Smith G.S.
        • Hu P.F.
        • Mackenzie C.F.
        • Scalea T.M.
        • et al.
        Repeat lactate level predicts mortality better than rate of clearance.
        Am J Emerg Med. 2018;
        • Singer A.J.
        • Taylor M.
        • Leblanc D.
        • Meyers K.
        • Perez K.
        • Thode H.C.
        • et al.
        Early point-of-care testing at triage reduces care time in stable adult emergency department patients.
        Am J Emerg Med. 2018; 55: 172-178
        • Fukumoto Y.
        • Inoue Y.
        • Takeuchi Y.
        • Hoshino T.
        • Nakamura Y.
        • Ishikawa K.
        • et al.
        Utility of blood lactate level in triage.
        Acute Medicine & Surgery. 2016; 3: 101-106
        • 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: 2118-2125
        • Cheung R.
        • Hoffman R.S.
        • Vlahov D.
        • Manini A.F.
        Prognostic utility of initial lactate in patients with acute drug overdose: a validation cohort.
        Annals of Emerge of Meidicine. 2018; 76: 16-23
        • Baxter J.
        • Cranfield K.R.
        • Clark G.
        • Harris T.
        • Bloom B.
        • Gray A.J.
        Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review.
        Journal of Trauma and Acure Surgery. 2016; 81: 555-566
        • Jansen T.C.
        • van Bommel J.
        • Mulder P.G.
        • Rommes J.H.
        • Schieveld S.J.M.
        • Bakker J.
        The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study.
        Crit Care. 2008; 12: R160
        • St John A.E.
        • McCoy A.M.
        • Moyes A.G.
        • Guyette F.X.
        • Bulger E.M.
        • Sayre M.R.
        Prehospital lactate predicts need for resuscitative care in non-hypotensive Trauma Patients.
        West J Emerg Med. 2018; 19: 224-231
        • Singer A.J.
        • Taylor M.
        • Domingo A.
        • Ghazipura S.
        • Khorasonchi A.
        • Thode H.C.
        • et al.
        Diagnostic characteristics of a clinical screening tool in combination with measuring bedside lactate level in emergency department patients with suspected sepsis.
        Acad Emerg Med. 2014; 21: 853-857
        • Boland L.L.
        • Hokanson J.S.
        • Fernstrom K.M.
        • Kinzy T.G.
        • Lick C.J.
        • Satterlee P.A.
        • et al.
        Prehospital lactate measurement by emergency medical services in patients meeting sepsis criteria.
        West J Emerg Med. 2016; 17: 648-655