Point-of-care lactate testing for sepsis at presentation to health care: a systematic review of patient outcomes

Research output: Contribution to journalArticlepeer-review

Authors

  • Elizabeth Morris
  • David McCartney
  • Ann Van den Bruel
  • Rebecca Fisher
  • Gail Hayward

Colleges, School and Institutes

External organisations

  • University of Oxford
  • Institute of Applied Health Research, University of Birmingham
  • Institutes of Metabolism and Systems Research (J.I., A.E.T., S.S., D.M.O., C.H.L.S., W.A.) and Cancer and Genomic Sciences (T.G.B.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Centres for Endocrinology, Diabetes and Metabolism (J.I., A.E.T., R.P.D., T.G.B., C.H.L.S., J.M.W.K., W.A.) and Rare Diseases and Personalised Medicine (T.G.B.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom; Departments of Paediatric Endocrinology and Diabetes (J.I., R.P.D., T.G.B., J.M.W.K.) and Paediatric Dermatology (C.M.), Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham B4 6NH, United Kingdom; MRC-Holland bv (R.V.), 1057-DN Amsterdam, The Netherlands; Department of Paediatric Endocrinology (R.A.), Great Ormond St Hospital for Children, London WC1N 3JH, United Kingdom; and Benioff Children's Hospital (C.H.L.S.), University of California San Francisco, Oakland, California 94609.

Abstract

BACKGROUND: Lactate is measured in hospital settings to identify patients with sepsis and severe infections, and to guide initiation of early treatment. Point-of-care technology could facilitate measurement of lactate by clinicians in the community. However, there has been little research into its utility in these environments.

AIM: To investigate the effect of using point-of-care lactate at presentation to health care on mortality and other clinical outcomes, in patients presenting with acute infections.

DESIGN AND SETTING: Studies comparing the use of point-of-care lactate to usual care in initial patient assessment at presentation to health care were identified using a maximally sensitive search strategy of six electronic databases.

METHOD: Two independent authors screened 3063 records for eligibility, and extracted data from eligible studies. Quality assessment for observational studies was performed using the ROBINS-I tool.

RESULTS: Eight studies were eligible for inclusion (3063 patients). Seven studies were recruited from emergency departments, and one from a pre-hospital aeromedical setting. Five studies demonstrated a trend towards reduced mortality with point-of-care lactate; three studies achieved statistical significance. One study demonstrated a significant reduction in length of hospital stay, although another did not find any significant difference. Two studies demonstrated a significant reduction in time to treatment for antibiotics and intravenous fluids.

CONCLUSION: This review identifies an evidence gap - there is no high-quality evidence to support the use of point-of-care lactate in community settings. There are no randomised controlled trials (RCTs) and no studies in primary care. RCT evidence from community settings is needed to evaluate this potentially beneficial diagnostic technology.

Details

Original languageEnglish
JournalBritish Journal of General Practice
Volume67
Issue number665
Early online date21 Nov 2017
Publication statusE-pub ahead of print - 21 Nov 2017

Keywords

  • Journal Article