Peripheral venous lactate levels substitute arterial lactate levels in the emergency department

Yasufumi Oi; Kosuke Mori; Hidehiro Yamagata; Ayako Nogaki; Tomoaki Takeda; Chikara Watanabe; Yusuke Sakaguchi; Fumihiro Ogawa; Takeru Abe; Shouhei Imaki; Ichiro Takeuchi

doi:10.1186/s12245-022-00410-y

Peripheral venous lactate levels substitute arterial lactate levels in the emergency department

Int J Emerg Med. 2022 Jan 28;15(1):7. doi: 10.1186/s12245-022-00410-y.

Authors

Yasufumi Oi^{1

2

3}, Kosuke Mori^{4

5}, Hidehiro Yamagata^{4

5

6}, Ayako Nogaki^{4

5}, Tomoaki Takeda^{4

5

6}, Chikara Watanabe^{4

5}, Yusuke Sakaguchi^{4

5}, Fumihiro Ogawa^{7

5}, Takeru Abe^{5

6}, Shouhei Imaki^{4

5}, Ichiro Takeuchi^{7

5

6}

Affiliations

¹ Emergency Care Department, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. yasu7azteca@ybb.ne.jp.
² Emergency and Critical Care Medical Center, Yokohama Municipal Citizen's Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. yasu7azteca@ybb.ne.jp.
³ Department of Emergency Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. yasu7azteca@ybb.ne.jp.
⁴ Emergency and Critical Care Medical Center, Yokohama Municipal Citizen's Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
⁵ Department of Emergency Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
⁶ Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
⁷ Emergency Care Department, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.

Abstract

Background: Arterial lactate (AL) level is an important predictor of patient prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. However, if the AL range can be predicted from PVL, PVL may be an alternative method for predicting patient prognosis, and the risk of arterial puncture complications with AL may be reduced. This could be a safe and rapid test method.

Methods: This was a retrospective observational study of 125 cases in which blood gas analysis was performed on both arterial and venous blood with an infectious disease in an emergency department. Spearman's rank correlation coefficient (r) and Bland-Altman analyses were performed. Sensitivity, specificity, and area under the curve (AUC) were calculated for PVL to predict AL < 2 mmol/L or < 4 mmol/L.

Results: The median [interquartile range] AL and PVL were 1.82 [1.25-2.46] vs. 2.08 [1.57-3.28], respectively, r was 0.93 (p < 0.0001), and a strong correlation was observed; however, Bland-Altman analysis showed disagreement. When AL < 2 mmol/L was used as the outcome, AUC was 0.970, the PVL cutoff value was 2.55 mmol/L, sensitivity was 85.71%, and specificity was 96.05%. If PVL < 2 mmol/L was the outcome, the sensitivity for AL < 2mmol/L was 100%, and for PVL levels ≥ 3 mmol/L, the specificity was 100%. When AL < 4 mmol/L was used as the outcome, AUC was 0.967, the PVL cutoff value was 3.4 mmol/L, sensitivity was 100%, and specificity was 85.84%. When PVL < 3.5 mmol/L was the outcome, the sensitivity for AL < 4 mmol/L was 100%, and for PVL levels ≥ 4 mmol/L, the specificity was 93.81%.

Conclusions: This study revealed that PVL and AL levels in the same critically ill patients did not perfectly agree with each other but were strongly correlated. Furthermore, the high accuracy for predicting AL ranges from PVL levels explains why PVL levels could be used as a substitute for AL level ranges.

Keywords: Arterial lactate; Blood gas analysis; Critical patients; Emergency service; Peripheral venous lactate.