Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1–infected patient population in Uganda
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Infectious Diseases Society of America
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Background: Prediction of mortality may improve management and outcomes of patients with sepsis in resource-limited settings. Therefore, we evaluated the ability of a hand-held portable whole-blood lactate (PWBL) analyzer to predict mortality of patients who are admitted to the hospital with severe sepsis. Methods: A prospective observational study enrolled 253 patients at a national referral hospital in Uganda. Inclusion criteria required (1) ≥2 systemic inflammatory response syndrome criteria or thermodysregulation, (2) hypotension, and (3) suspected infection. A subset of 72 patients had PWBL and standard laboratory serum lactate measured. The primary measured outcome was in-hospital mortality. Results: Fifty-nine (81.9%) of 72 evaluated patients were infected with human immunodeficiency virus type 1. The in-hospital mortality rate was 25.7% (18 of 70), and the in- and outpatient mortality at 30 days was 41.6% (30 of 72). PWBL was positively associated with in-hospital but not outpatient mortality (P <.001 ). The receiver operating characteristic area under the curve for PWBL was 0.81 (P < .001). The optimal PWBL concentration for predicting in-hospital mortality (sensitivity, 88.3%; specificity, 71.2%) was ≥4.0 mmol/L. Patients with a PWBL concentration ≥4.0 mmol/L died while in the hospital substantially more often (50.0%) than did those with a PWBL concentration <4.0 mmol/L (7.5%) (odds ratio, 12.3; 95% confidence interval, 3.5–48.9; P <.001). Standard laboratory serum lactate results were inconsistent and less predictive of mortality than were those of PWBL in a multiple logistic regression model. Conclusion: A PWBL concentration ≥4.0 mmol/L predicts with 81% accuracy a 7-fold higher mortality of patients with sepsis than does a PWBL concentration <4.0 mmol/L. PWBL testing would be useful in places where clinical decisions are limited by lack of laboratory infrastructure and poor reliability.
This study was supported, in part, by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health. C.C.M. and S.T.J. received fellowships from the Pfizer Initiative in International Health at the University of Virginia to support this work.
This study was supported, in part, by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health. C.C.M. and S.T.J. received fellowships from the Pfizer Initiative in International Health at the University of Virginia to support this work.
Keywords
HIV Type 1–Infected, Mortality, Sepsis, Resource-limited settings, Portable whole-blood lactate (PWBL), HIV/AIDS