Elevated lactate levels can signify increased risk of mortality among sepsis patients; however, a significant number of patients do not have their lactate levels measured in the recommended timeframe, according to a study published in CHEST.
The Severe Sepsis and Septic Shock Early Management Bundle issued by CMS in 2015 recommends that serum lactate be measured between six hours before and three hours after severe sepsis presentation, followed by another measurement within six hours of presentation if the initial lactate is elevated.
Researchers examined records of around 150,000 patients at a single tertiary care academic hospital from November 2008 to January 2016. They identified 5,762 admissions that met the three SEP-1 criteria within a six-hour period, of which only 60 percent had an initial lactate drawn within the recommended timeframe. Fourteen percent had their levels measured between three and 24 hours after severe sepsis presentation, while 25 percent did not have their lactates measured at all.
Researchers found death risk increased with higher initial lactate levels — 60 percent of intensive care unit patients with elevated lactate levels died as compared to 35 percent of those with normal initial lactate levels. Each delay of measurements by an hour was associated with a 2 percent increase in the odds of in-hospital death.
Also, 79 percent of patients treated in the emergency department had lactate levels measured within the recommended timeframe as compared with 55 percent in the ICU and only 32 percent in hospital wards