Effectiveness of arterial, venous, and capillary blood lactate as a sepsis triage tool in ED patients
Abstract
Objective We evaluate the capacity of arterial (ABL), peripheral venous (VBL), and capillary (CBL) blood lactate concentration to early detect the presence of severe sepsis in patients admitted to the emergency department for a septic syndrome.Methods Patients with signs of sepsis presenting to the emergency department were prospectively enrolled. Blood lactate was measured using a handheld point-of-care analyzer on microsamples of arterial, peripheral venous, and capillary blood. An arterial blood sample was dispatched to the central laboratory as a reference measurement.Results A total of 103 patients were enrolled in the study, with 63 patients presenting with a severe sepsis. There was a strong correlation between the point of care and the reference blood lactate measurement. The CBL, VBL, and ABL were all significantly different (3.01±0.29, 2.51±0.21, and 2.03±0.18 mmol/L, respectively; P<.001). The VBL value was the most efficient to detect early the presence of severe sepsis (areas under the receiver operating characteristic curves were 0.85±0.04, 0.76±0.05, and 0.75±0.05 for VBL, ABL, and CBL, respectively; P<.01). Mortality at 28 days was related to the severity of sepsis (28.6% vs 7.5%) and to the number or organ dysfunctions (P<.01). Arterial blood lactate, VBL, and CBL were all significantly associated with the 28th-day mortality.Conclusions Initial VBL may be used efficiently to assess the severity of sepsis, and it could even be more effective than ABL and CBL to early detect the presence of severe sepsis.
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Lactate alone is neither sensitive nor specific enough to rule in or rule out sepsis.
“However, lactate alone is neither sensitive nor specific enough to rule-in or rule-out the diagnosis on its own.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [50]
Lactate cutoffs for an elevated level ranged from 1.6 to 2.5 mmol/L, with similar diagnostic characteristics regardless of cutoff.
“The lactate cutoffs determining an elevated level ranged from 1.6 to 2.5 mmol/L, although diagnostic characteristics were similar regardless of the cutoff.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [50]
Pooled positive and negative likelihood ratios from three studies for lactate in suspected sepsis are 4.75 and 0.29, respectively.
“Pooled positive and negative likelihood ratios from the three studies are 4.75 and 0.29, respectively.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [50]
For lactate as a sepsis screen, sensitivities range from 66 to 83% and specificities from 80 to 85%.
“Sensitivities range from 66 to 83%, with specificities ranging from 80 to 85%.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [50]
An elevated lactate level increases and a normal lactate level decreases the likelihood of a final diagnosis of sepsis in patients with suspected sepsis.
“In summary, the presence of an elevated or normal lactate level significantly increases or decreases, respectively, the likelihood of a final diagnosis of sepsis in patients with suspected sepsis.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [50]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
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- Authors
- Contenti, J., Corraze, H., Lemoël, F., & Levraut, J.
- Affiliations
- Centre Hospitalier Universitaire de Nice (FR)
- Corresponding author
- Levraut, Jacques
- Venue
- The American Journal of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 33
- Issue
- 2
- Pages
- 167-172
- ISSN
- 0735-6757 (ISSN-L)
- OpenAlex
- W2089146960
- Cited by
- 60
- References
- 36
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 7 · 2018: 7 · 2017: 8 · 2016: 5 · 2015: 5
- FWCI
- 4.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- sepsis, blood lactate, venous blood lactate, capillary blood lactate, arterial lactate, sepsis severity, 28-day mortality, point-of-care testing, emergency department, organ dysfunction
- MeSH terms
- Aged, Arteries, Blood Specimen Collection, Capillaries, Emergency Service, Hospital, Female, Humans, Male, Prospective Studies, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Triage, Veins, Sepsis, Point-of-Care Systems, Lactic Acid
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