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Hyperlactatemia on ICU admission

Comparison between direct admissions and inpatient transfers

Hyperlaktatämie bei Aufnahme auf die Intensivstation

Vergleich zwischen direkt aufgenommenen und intern verlegten Patienten

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Abstract

Background

Hyperlactatemia is associated with increased mortality. Possible differences between patients directly admitted via the emergency department to the intensive care unit (ICU) and inpatient transfers to the ICU have not yet been investigated.

Materials and methods

In this retrospective analysis, characteristics and outcomes between critically ill medical inpatient transfers and direct admissions with hyperlactatemia on ICU admission, defined as a blood lactate >2 mmol/l, were compared.

Results

A total of 1042 patients were included, with 424 inpatient transfers and 618 direct admissions. The median age of inpatient transfers and direct admissions was 67.0 and 70.5 years, respectively (P = 0.03). The median APACHE II score was 25 for inpatient transfers and 23 for direct admissions (P = 0.01). The median blood lactate on ICU admission for inpatient transfers and direct admissions was similar (3.6 vs. 3.5 mmol/l). Sepsis was more common among inpatient transfers than direct admissions (53.5 vs. 31.6%, P = 0.001). The ICU (39.6 vs. 28.8%, P < 0.001), hospital (56.8 vs. 38.3%, P < 0.001) and 28-day mortality (46.5 vs. 35.4%, P < 0.001) was significantly higher for inpatient transfers than direct admissions. Among the sepsis cohort, inpatient transfer, APACHE II score and elevated blood lactate were independent predictors of ICU mortality.

Conclusion

Among medical ICU patients with admission hyperlactatemia, the median blood lactate was not significantly different between direct admissions and inpatient referrals. Inpatients with sepsis may have been referred to the ICU late.

Zusammenfassung

Hintergrund

Hyperlaktatämie ist mit erhöhter Mortalität assoziiert. Mögliche Unterschiede zwischen Patienten, die direkt über die Notaufnahme auf die Intensivstation aufgenommen werden, und Patienten, die intern auf die Intensivstation verlegt werden, wurde bisher nicht untersucht.

Material und Methode

In dieser retrospektiven Analyse wurden Charakteristika und Ausgang von kritisch kranken internistischen Patienten mit Hyperlaktatämie, definiert als Blutlaktat >2 mmol/l, bei Aufnahme auf die Intensivstation, die direkt über die Notaufnahme aufgenommen wurden, vs. Patienten, die intern auf die Intensivstation verlegt wurden, verglichen.

Ergebnisse

Insgesamt wurden 1042 Patienten eingeschlossen, von denen 424 interne Verlegungen und 618 direkte Aufnahmen waren. Das mediane Alter betrug 67,0 Jahre bei den internen Verlegungen und 70,5 Jahre bei den direkten Aufnahmen (p = 0,03). Der mediane APACHE-II-Score betrug 25 bei den internen Verlegungen und 23 bei den direkten Aufnahmen (p = 0,01). Der mediane Laktatwert bei Aufnahme auf die Intensivstation war zwischen beiden Gruppen ähnlich (3,6 vs. 3,5 mmol/l). Sepsis war bei den internen Verlegungen häufiger als bei den direkten Aufnahmen (53,5 % vs. 31,6 %, p = 0,001). Die intensivmedizinische (39,6 vs. 28,8 %, p < 0,001), Krankenhaus- (56,8 vs. 38,3 %, p < 0,001) und 28-Tage-Mortalität (46,5 vs. 35,4 %, p < 0,001) war bei den internen Verlegungen signifikant höher als bei den direkten Aufnahmen. In der Sepsiskohorte waren interne Verlegung, APACHE-II-Score und erhöhter Laktatwert unabhängige Prädiktoren einer Sterblichkeit auf der Intensivstation.

Schlussfolgerung

Bei kritisch kranken internistischen Patienten mit Hyperlaktatämie zeigte der Blutlaktatwert zwischen den direkten Aufnahmen und den internen Verlegungen bei Aufnahme auf die Intensivstation keinen signifikanten Unterschied. Intern verlegte Patienten mit Sepsis wurden möglicherweise zu spät auf die Intensivstation verlegt.

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Acknowledgements

We thank the staff of our emergency department and our medical ICU for continuous help during data compilation.

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Authors and Affiliations

  1. Medical ICU, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany

    A. F. Peschka, S. Kaestle, F. Seidel, L. Weidhase &  S. Petros

  2. Emergency Department, University Hospital Düsseldorf, Düsseldorf, Germany

    M. Bernhard

  3. Emergency Department, University Hospital of Leipzig, Leipzig, Germany

    A. Gries

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  1. A. F. Peschka
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  2. S. Kaestle
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  3. F. Seidel
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  4. L. Weidhase
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  5. M. Bernhard
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  7. S. Petros
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Correspondence to S. Petros.

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Conflict of interest

A.F. Peschka, S. Kaestle, F. Seidel, L. Weidhase, M. Bernhard, A. Gries and S. Petros declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Peschka, A.F., Kaestle, S., Seidel, F. et al. Hyperlactatemia on ICU admission. Med Klin Intensivmed Notfmed 114, 650–654 (2019). https://doi.org/10.1007/s00063-018-0468-0

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  • DOI: https://doi.org/10.1007/s00063-018-0468-0

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