Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study

Background: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, the clinical picture alone is not sufficient for assessing disease severity and outcomes. Because blood lactate level is included in t...

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Main Authors: Romain Jouffroy, Teddy Léguillier, Basile Gilbert, Jean Pierre Tourtier, Emmanuel Bloch-Laine, Patrick Ecollan, Vincent Bounes, Josiane Boularan, Papa Gueye-Ngalgou, Valérie Nivet-Antoine, Jean-Louis Beaudeux, Benoit Vivien
Format: Article
Language:English
Published: MDPI AG 2020-10-01
Series:Journal of Clinical Medicine
Subjects:
Online Access:https://www.mdpi.com/2077-0383/9/10/3290
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spelling doaj-4a96d8d3f9c1473d93223627afcffdd32020-11-25T03:58:29ZengMDPI AGJournal of Clinical Medicine2077-03832020-10-0193290329010.3390/jcm9103290Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS StudyRomain Jouffroy0Teddy Léguillier1Basile Gilbert2Jean Pierre Tourtier3Emmanuel Bloch-Laine4Patrick Ecollan5Vincent Bounes6Josiane Boularan7Papa Gueye-Ngalgou8Valérie Nivet-Antoine9Jean-Louis Beaudeux10Benoit Vivien11Intensive Care Unit, Ambroise Paré Hospital—Assistance Publique Hôpitaux de Paris, 92100 Boulogne Billancourt, FranceDepartment of Clinical Biochemistry, Necker Hospital, Assistance Publique—Hôpitaux de Paris, 75015 Paris, FranceDepartment of Emergency Medicine, SAMU 31, University Hospital of Toulouse, 31000 Toulouse, FranceEmergency Medicine Department, 1 Place Jules Renard, Paris Fire Brigade, 75017 Paris, FranceEmergency Department, Cochin Hospital, Paris, France & Emergency Department, SMUR, Hôtel Dieu Hospital, 75014 Paris, FranceIntensive Care Unit, SMUR, Pitie Salpêtriere Hospital, 47 Boulevard de l’Hôpital, 75013 Paris, FranceDepartment of Emergency Medicine, SAMU 31, University Hospital of Toulouse, 31000 Toulouse, FranceEmergency Department, SAMU 31, Castres Hospital, 81108 Castres, FranceEmergency Department, SAMU 972, CHU de Martinique Pierre Zobda—Quitman Hospital, 90632 Fort-de-France Martinique, FranceDepartment of Clinical Biochemistry, Necker Hospital, Assistance Publique—Hôpitaux de Paris, 75015 Paris, FranceDepartment of Clinical Biochemistry, Necker Hospital, Assistance Publique—Hôpitaux de Paris, 75015 Paris, FranceIntensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique—Hôpitaux de Paris, 75015 Paris, FranceBackground: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, the clinical picture alone is not sufficient for assessing disease severity and outcomes. Because blood lactate level is included in the clinical criteria of SS it should be considered to improve the assessment of its severity. This study aims to investigate the relationship between pre-hospital blood lactate level and 30-day mortality in patients with SS. Methods: From 15 April 2017 to 15 April 2019, patients with SS requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were prospectively included in the LAPHSUS study, an observational, non-randomized controlled study. Pre-hospital blood lactate levels were measured at the time of first contact between the patients and the MICU. Results: Among the 183 patients with septic shock requiring action by the MICU drawn at random from LAPHSUS study patients, six (3%) were lost to follow-up on the 30th day and thus 177 (97%) were analyzed for blood lactate levels (mean age 70 ± 14 years). Pulmonary, urinary and digestive infections were probably the cause of the SS in respectively 58%, 21% and 11% of the cases. The 30-day overall mortality was 32%. Mean pre-hospital lactatemia was significantly different between patients who died and those who survived (respectively 7.1 ± 4.0 mmol/L vs. 5.9 ± 3.5 mmol/L, <i>p</i> < 10<sup>−3</sup>). Using Cox regression analysis adjusted for potential confounders we showed that a pre-hospital blood lactate level ≥ 4 mmol/L significantly predicted 30-day mortality in patients with SS (adjusted hazard ratio = 2.37, 95%CI (1.01–5.57), <i>p</i> = 0.04). Conclusion: In this study, we showed that pre-hospital lactatemia predicts 30-day mortality in patients with septic shock handled by the MICU. Further studies will be needed to evaluate if pre-hospital lactatemia alone or combined with clinical scores could affect the triage decision-making process for those patients.https://www.mdpi.com/2077-0383/9/10/3290severe sepsisseptic shockblood lactatepre-hospital settingprediction
collection DOAJ
language English
format Article
sources DOAJ
author Romain Jouffroy
Teddy Léguillier
Basile Gilbert
Jean Pierre Tourtier
Emmanuel Bloch-Laine
Patrick Ecollan
Vincent Bounes
Josiane Boularan
Papa Gueye-Ngalgou
Valérie Nivet-Antoine
Jean-Louis Beaudeux
Benoit Vivien
spellingShingle Romain Jouffroy
Teddy Léguillier
Basile Gilbert
Jean Pierre Tourtier
Emmanuel Bloch-Laine
Patrick Ecollan
Vincent Bounes
Josiane Boularan
Papa Gueye-Ngalgou
Valérie Nivet-Antoine
Jean-Louis Beaudeux
Benoit Vivien
Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study
Journal of Clinical Medicine
severe sepsis
septic shock
blood lactate
pre-hospital setting
prediction
author_facet Romain Jouffroy
Teddy Léguillier
Basile Gilbert
Jean Pierre Tourtier
Emmanuel Bloch-Laine
Patrick Ecollan
Vincent Bounes
Josiane Boularan
Papa Gueye-Ngalgou
Valérie Nivet-Antoine
Jean-Louis Beaudeux
Benoit Vivien
author_sort Romain Jouffroy
title Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study
title_short Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study
title_full Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study
title_fullStr Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study
title_full_unstemmed Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study
title_sort pre-hospital lactatemia predicts 30-day mortality in patients with septic shock—preliminary results from the laphsus study
publisher MDPI AG
series Journal of Clinical Medicine
issn 2077-0383
publishDate 2020-10-01
description Background: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, the clinical picture alone is not sufficient for assessing disease severity and outcomes. Because blood lactate level is included in the clinical criteria of SS it should be considered to improve the assessment of its severity. This study aims to investigate the relationship between pre-hospital blood lactate level and 30-day mortality in patients with SS. Methods: From 15 April 2017 to 15 April 2019, patients with SS requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were prospectively included in the LAPHSUS study, an observational, non-randomized controlled study. Pre-hospital blood lactate levels were measured at the time of first contact between the patients and the MICU. Results: Among the 183 patients with septic shock requiring action by the MICU drawn at random from LAPHSUS study patients, six (3%) were lost to follow-up on the 30th day and thus 177 (97%) were analyzed for blood lactate levels (mean age 70 ± 14 years). Pulmonary, urinary and digestive infections were probably the cause of the SS in respectively 58%, 21% and 11% of the cases. The 30-day overall mortality was 32%. Mean pre-hospital lactatemia was significantly different between patients who died and those who survived (respectively 7.1 ± 4.0 mmol/L vs. 5.9 ± 3.5 mmol/L, <i>p</i> < 10<sup>−3</sup>). Using Cox regression analysis adjusted for potential confounders we showed that a pre-hospital blood lactate level ≥ 4 mmol/L significantly predicted 30-day mortality in patients with SS (adjusted hazard ratio = 2.37, 95%CI (1.01–5.57), <i>p</i> = 0.04). Conclusion: In this study, we showed that pre-hospital lactatemia predicts 30-day mortality in patients with septic shock handled by the MICU. Further studies will be needed to evaluate if pre-hospital lactatemia alone or combined with clinical scores could affect the triage decision-making process for those patients.
topic severe sepsis
septic shock
blood lactate
pre-hospital setting
prediction
url https://www.mdpi.com/2077-0383/9/10/3290
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