Abstract
Background
In the Emergency Department, lactate measurement is a useful tool to risk-stratify
critically ill patients. However, it is unclear whether arterial or peripheral venous
lactate levels can be used interchangeably for this purpose. In this systematic review,
we provide an overview of studies investigating the agreement between arterial and
peripheral venous lactate levels in the Emergency Department.
Methods
PubMed, Embase, the Cochrane Central Register of Controlled Trials/Wiley, Web of Science/Clarivate
Analytics, and references of selected articles were assessed for all studies comparing
arterial and peripheral venous lactate levels in adult patients in the emergency department.
Two reviewers independently screened all potentially relevant titles and abstracts
for eligibility using a standardized data-worksheet.
Results
Nine studies were included. Peripheral venous lactate levels tend to be higher than
arterial lactate levels with mean differences ranging from 0.18 mmol/l to 1.06 mmol/l.
Importantly, poorer agreement occurs in hyperlactatemia. At a cut-of level of 1.6 mmol/l,
peripheral venous lactate can rule out arterial hyperlactatemia with a sensitivity
between 94% and 100%. At a cut off value of 2 mmol/l, sensitivities of 97% and 100%
were found.
Conclusion
Agreement between arterial and peripheral venous lactate is poor in hyperlactatemia,
making peripheral venous lactate an unreliable parameter to use interchangeably in
the ED. In clinical practice, peripheral venous lactate can be used as a screening
tool to rule out arterial hyperlactatemia at a cut-off value of 2 mmol/l. However,
hyperlactatemia should be confirmed using arterial sampling in case of a peripheral
venous lactate level > 2 mmol/l.
Keywords
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References
- Lactic Acidosis.N Engl J Med. 2014; 371: 2309-2319
- Acidosis and alkalosis.in: Longo Harrison's principles of internal medicine. 18e. McGraw-Hill, New York, NY2012: 366
- 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: 74
- Arterial lactate levels in an emergency department are associated with mortality: a prospective observational cohort study.Emerg Med J. 2015; 32: 673-677
- Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study.Scand J Trauma Resusc Emerg Med. 2017; 25
- Blood lactate measurement within the emergency department: a two-year retrospective analysis.Am J Emerg Med. 2018; https://doi.org/10.1016/j.ajem.2018.05.065
- Lactate measurements in sepsis-induced tissue hypoperfusion: results from the surviving sepsis campaign database.Crit Care Med. 2015; 43 ([PubMed: 25479113]): 567-573
- Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by sepsis-3.Crit Care Med. 2018; 46
- Lactate: biomarker and potential therapeutic target.Crit Care Clin. 2011; 27: 299-326
- The third international consensus definitions for Sepsis and septic shock (sepsis-3).JAMA. 2016; 315: 801-810
- Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock.Intensive Care Med. 2012; 39: 165-228
- The surviving sepsis campaign bundle: 2018 update.Crit Care Med. 2018; 46: 997-1000
- Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis.Respirology. 2014; 19: 168-175
- The role of venous blood gas in the emergency department: a systematic review.Eur J Emerg Med. 2014; 21: 81-88
- Statistical methods for assessing agreement between two methods of clinical measurement.Lancet. 1986; : 307-310
- Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation.BMJ. 2015; 349: g7647https://doi.org/10.1136/bmj.g7647
- Rayyan — a web and mobile app for systematic reviews.Syst Rev. 2016; 5: 210https://doi.org/10.1186/s13643-016-0384-4
- Relationship between arterial and peripheral venous lactate levels.Acad Emerg Med. 1996; 3: 730-734
- Agreement between peripheral venous and arterial lactate levels.Ann Emerg Med. 1997; 29: 479-483
- Can we predict arterial lactate from venous lactate in the ED?.Am J Emerg Med. 2013; 31: 1118-1120
- Agreement between arterial and venous lactate in emergency department patients: a prospective study of 157 consecutive patients.Eur J Emerg Med. 2018 Apr; 25: 92-96
- Effectiveness of arterial, venous, and capillary blood lactate as a sepsis triage tool in ED patients.Am J Emerg Med. 2015; 33: 167-172
- Peripheral venous and arterial lactate agreement in septic patients in the emergency department: a pilot study.Eur J Emerg Med. 2014; 21: 139-141
- Lactate - arterial and venous agreement in Sepsis: a prospective observational study.Eur J Emerg Med. 2018 Apr; 25: 85-91
- The utility of venous lactate to triage injured patients in the trauma center.J Am Coll Surg. 2000; 190: 656-664
- The agreement between abnormal venous lactate and arterial lactate in the ED: a retrospective chart review.Am J Emerg Med. 2014; 32: 596-600
- Can peripheral venous blood gases replace arterial blood gases in emergency department patients?.CJEM. 2002; 4: 7-15
- The correlation between arterial lactate and venous lactate in patients with sepsis and septic shock.J Intensive Care Med. 2018; 33: 116-120
- Comparison of lactate values obtained from different sites and their clinical significance in patients with severe sepsis.Sao Paulo Med J. 2011; 129: 11-16
Article Info
Publication History
Published online: January 21, 2019
Accepted:
January 21,
2019
Received in revised form:
January 19,
2019
Received:
December 10,
2018
Footnotes
☆All authors have disclosed that they do not have any potential conflict of interest.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
