Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda

Christopher C. Moore, Shevin T. Jacob, Relana Pinkerton, David B. Meya, Harriet Mayanja-Kizza, Steven James Reynolds, W. Michael Scheld

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish (US)
Pages (from-to)215-222
Number of pages8
JournalClinical Infectious Diseases
Volume46
Issue number2
DOIs
StatePublished - Jan 15 2008

Fingerprint

Uganda
HIV-1
Lactic Acid
Sepsis
Mortality
Population
Hospital Mortality
Outpatients
Systemic Inflammatory Response Syndrome
Point-of-Care Testing
ROC Curve
Hypotension
Area Under Curve
Observational Studies
Inpatients
Referral and Consultation
Hand
Prospective Studies
Infection
Serum

ASJC Scopus subject areas

  • Immunology

Cite this

Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda. / Moore, Christopher C.; Jacob, Shevin T.; Pinkerton, Relana; Meya, David B.; Mayanja-Kizza, Harriet; Reynolds, Steven James; Scheld, W. Michael.

In: Clinical Infectious Diseases, Vol. 46, No. 2, 15.01.2008, p. 215-222.

Research output: Contribution to journalArticle

Moore, Christopher C. ; Jacob, Shevin T. ; Pinkerton, Relana ; Meya, David B. ; Mayanja-Kizza, Harriet ; Reynolds, Steven James ; Scheld, W. Michael. / Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda. In: Clinical Infectious Diseases. 2008 ; Vol. 46, No. 2. pp. 215-222.
@article{7f22ea866a7c443eb27d6c3808b73a99,
title = "Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda",
abstract = "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",
author = "Moore, {Christopher C.} and Jacob, {Shevin T.} and Relana Pinkerton and Meya, {David B.} and Harriet Mayanja-Kizza and Reynolds, {Steven James} and Scheld, {W. Michael}",
year = "2008",
month = "1",
day = "15",
doi = "10.1086/524665",
language = "English (US)",
volume = "46",
pages = "215--222",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "2",

}

TY - JOUR

T1 - Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda

AU - Moore, Christopher C.

AU - Jacob, Shevin T.

AU - Pinkerton, Relana

AU - Meya, David B.

AU - Mayanja-Kizza, Harriet

AU - Reynolds, Steven James

AU - Scheld, W. Michael

PY - 2008/1/15

Y1 - 2008/1/15

N2 - 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

AB - 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

UR - http://www.scopus.com/inward/record.url?scp=39449119819&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=39449119819&partnerID=8YFLogxK

U2 - 10.1086/524665

DO - 10.1086/524665

M3 - Article

VL - 46

SP - 215

EP - 222

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 2

ER -