Point Of Care Lactate Testing Predicts Mortality Of Severe Sepsis In A Predominantly HIV Type 1-Infected Patient Population In Uganda

To evaluate the ability of a handheld portable whole-blood lactate (PWBL) analyzer to predict mortality in patients who are admitted to the hospital with severe sepsis.

72 patients were enrolled in the study. Inclusion criteria were ≥18 years of age and admission to a medical ward, along with: 1. two or more systemic inflammatory response syndrome criteria (body temperature, >38°C or <36°C; heart rate, >90 beats/min; respiratory rate, >20 breaths/min; or peripheral WBC concentration, >12,000 cells/mm³ or <4000 cells/mm³; or thermodysregulation; 2. systolic blood pressure ≤100 mm Hg; and 3. a suspected infection. Exclusion criteria included acute cerebrovascular events, gastrointestinal hemorrhage, or admission to the surgical or obstetrics and gynecology ward.

The authors conclude that PWBL testing can quickly identify patients who require immediate interventions, and it should be included in evaluation and treatment algorithms for septic patients. PWBL testing could be used in village health posts, for earlier transfer of septic patients to facilities with a higher level of care, and in referral hospitals, for triage of patients to acute care settings where appropriate resuscitation can begin. The use of the PWBL and its value in predicting mortality from sepsis in populations with high prevalence of HIV has potential to assist health care workers in resource limited settings in prioritizing these patients. Hospitalization, availability of support for potential multi-system failure, and rapid administration of antimicrobial agents can be delivered more urgently in persons with high lactate concentrations.