Utility of serum lactate to predict drug-overdose fatality

Autor:	Alex F. Manini, David Vlahov, Robert S. Hoffman, Dean Olsen, Ashwini Kumar
Rok vydání:	2010
Předmět:	Adult Male medicine.medical_specialty Poison control Context (language use) Toxicology Drug overdose Article medicine Humans Lactic Acid Intensive care medicine Aged business.industry Medical record Medical examiner Case-control study General Medicine Emergency department Carbon Dioxide Middle Aged medicine.disease Poison control center ROC Curve Case-Control Studies Emergency medicine Female Drug Overdose Emergency Service Hospital business
Zdroj:	Clinical Toxicology. 48:730-736
ISSN:	1556-9519 1556-3650
DOI:	10.3109/15563650.2010.504187
Popis:	Poisoning is the second leading cause of injury-related fatality in the United States. An elevated serum lactate concentration identifies medical and surgical patients at risk for death; however, its utility in predicting death in drug overdose is controversial and unclear.We aimed to evaluate the prognostic utility of serum lactate concentration for fatality in emergency department (ED) patients with acute drug overdose.This was a case-control study at two urban university teaching hospitals affiliated with a regional poison control center. Data were obtained from electronic medical records, poison center data, and the office of the chief medical examiner. Controls were consecutive acute drug overdoses over a 1-year period surviving to hospital discharge. Cases were subjects over a 7-year period with fatality because of drug overdose. Serum lactate concentration was obtained from the initial blood draw in the ED and correlated with fatality.During the study period, 873 subjects were screened with 50 cases and 100 controls included. Drug exposures and baseline characteristics were similar between groups. Mean lactate concentration (mmol/L) was 9.88 ± 6.7 for cases and 2.76 ± 2.9 for controls (p0.001). The receiver operating characteristic area under the curve for prediction of fatality was 0.87 (95% CI: 0.81-0.94). The optimal lactate cutpoint was 3.0 mmol/L (84% sensitivity, 75% specificity), which conferred a 15.8-fold increase in odds of fatality (p0.001).In this derivation study, serum lactate concentration had excellent prognostic utility to predict drug-overdose fatality. Prospective validation in the ED evaluation of drug overdoses is warranted.
Databáze:	OpenAIRE
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