Introduction
Patients and methods
Study population
Airway and breathing problems (“airway” and “breathing”) | |
- airway obstruction (e.g. tongue swelling) - respiratory insufficiency with high respiratory rate (with respiratory weakness) or low oxygen saturation - necessity for invasive airway management - invasive and non-invasive mechanical ventilation | |
Circulation problems (“circulation”) | |
- cardiovascular insufficiency (e.g. hypotension, shock of any origin) - state after or under cardiopulmonary resuscitation - dysrhythmias - bleeding | |
Unconsciousness or neurological deficit (“disability”) | |
- ongoing unconsciousness of any origin | |
Critical physical state (“environment”) | |
- intoxication with an ABCDE problem - rhabdomyolysis - hypothermia |
Study outcomes
Statistical analysis
Results
Patient population
Admission lactate level category (mmol/l) | |||||||
---|---|---|---|---|---|---|---|
0.0–1.9 | 2.0–3.9 | 4.0–5.9 | 6.0–7.9 | 8.0–9.9 | ≥10 | all | |
no. (%) | 154 (29.4%) | 146 (27.9%) | 74 (14.1%) | 43 (8.2%) | 22 (4.2%) | 84 (16.1%) | 523 (100.0%) |
male no. (%) | 85 (55.2%) | 80 (54.8%) | 45 (60.8%) | 22 (51.1%) | 13 (59.1%) | 58 (69.4%) | 303 (57.9%) |
Age – yr | 68.6 ± 17.6 | 67.8 ± 17.5 | 69.7 ± 15.3 | 67.4 ± 16.3 | 72.4 ± 16.7 | 63.9 ± 16.4 | 67.8 ± 17.6 |
SBP - mmHg | 145.5 ± 45.9 | 136.5 ± 44.9 | 130.7 ± 44.7 | 133.4 ± 57.1 | 121.2 ± 64.5 | 110.3 ± 66.0 | 134.7 ± 56.6 |
Hypotensive no. (%) | 11 (7.1%) | 21 (14.4%) | 14 (18.9%) | 12 (27.9%) | 10 (45.5%) | 47 (56.0%) | 115 (22.0%) |
CPR adm.no. (%) | 2 (1.3%) | 5 (3.4) | 1 (1.4%) | 2 (4.7%) | 3 (13.6%) | 27 (32.1%) | 39 (7.5%) |
HR (X/min) | 92.8 ± 28.2 | 94.9 ± 32.6 | 96.1 ± 35.7 | 108.6 ± 32.9 | 106.9 ± 48.0 | 96.0 ± 52.0 | 96.0 ± 38.0 |
Temp tymp. - °C | 36.5 ± 14.5 | 36.2 ± 13.1 | 36.4 ± 15.4 | 36.4 ± 11.8 | 36.1 ± 15.5 | 35.4 ± 15.5 | 36.2 ± 14.3 |
Oxygen sat. - % | 93.1 ± 13.6 | 91.6 ± 14.6 | 92.4 ± 9.3 | 87.6 ± 23.4 | 93.1 ± 28.6 | 88.7 ± 39.1 | 91.5 ± 22.6 |
RR - (x/min) | 19.1 ± 9.5 | 20.3 ± 10.3 | 21.9 ± 11.5 | 23.7 ± 10.3 | 19.6 ± 9.2 | 16.4 ± 7.5 | 19.8 ± 10.0 |
GCS | 9.8 ± 4.8 | 9.2 ± 5.0 | 9.2 ± 5.1 | 8.5 ± 4.9 | 5.7 ± 4.3 | 4.2 ± 2.9 | 8.4 ± 5.1 |
Shock Index | 0.7 ± 0.3 | 0.8 ± 0.4 | 0.8 ± 0.5 | 0.9 ± 0.5 | 1.1 ± 0.6 | 1.0 ± 0.7 | 0.8 ± 0.5 |
Adm. MV no. (%) | 43 (27.9%) | 39 (26.7%) | 26 (35.1%) | 9 (20.9%) | 12 (54.5%) | 62 (73.8%) | 191 (36.5%) |
Invasive no. (%) | 27 (17.5%) | 29 (19.9%) | 18 (24.3%) | 7 (16.3%) | 12 (54.5%) | 62 (73.8%) | 155 (29.6%) |
Non-invasive no. (%) | 16 (10.4%) | 10 (6.8%) | 8 (10.8%) | 2 (4.6%) | 0 (0.0%) | 0 (0.0%) | 36 (6.9%) |
24 h mortality no. (%) | 3 (1.9%) | 2 (1.4%) | 3 (4.1%) | 4 (9.3%) | 3 (13.6%) | 27 (31.8%) | 42 (8.0%) |
30 d mortality no. (%) | 35 (22.7%) | 39 (26.7%) | 21 (28.4%) | 16 (37.2%) | 10 (45.5%) | 58 (69.0%) | 179 (34.2%) |
Admission lactate level category (mmol/l) | |||||||
---|---|---|---|---|---|---|---|
0.0–1.9 | 2.0–3.9 | 4.0–5.9 | 6.0–7.9 | 8.0–9.9 | ≥10 | all | |
no. (%) | 154 (29.4%) | 146 (27.9%) | 74 (14.1%) | 43 (8.2%) | 22 (4.2%) | 84 (16.1%) | 523 (100.0%) |
Sepsis | 15 (9.7%) | 10 (6.8%) | 12 (16.2%) | 6 (14.0%) | 1 (4.5%) | 10 (11.9%) | 54 (10.3%) |
Lower respiratory tract | 9 (5.8%) | 5 (3.4%) | 4 (5.4%) | 4 (9.3%) | 0 (0.0%) | 5 (6.0%) | 27 (5.2%) |
Urinary tract infection | 5 (3.2%) | 3 (2.1%) | 2 (2.7%) | 2 (4.7%) | 1 (4.5%) | 0 (0.0%) | 13 (2.5%) |
Intra-abdominal | 0 (0.0%) | 0 (0.0%) | 2 (2.7%) | 0 (0.0%) | 0 (0.0%) | 1 (1.2%) | 3 (0.6%) |
Other | 1 (0.6%) | 2 (1.4%) | 4 (5.4%) | 0 (0.0%) | 0 (0.0%) | 4 (4.8%) | 11 (2.1%) |
Lung disease | 36 (23.4%) | 23 (15.8%) | 11 (15.1%) | 7 (16.3%) | 3 (13.6%) | 6 (7.1%) | 86 (16.4%) |
COPD | 15 (9.7%) | 13 (8.9%) | 4 (5.5%) | 3 (7.0%) | 2 (9.1%) | 4 (4.8%) | 41 (7.8%) |
Pneumonia | 14 (9.1%) | 0 (0.0%) | 5 (6.8%) | 4 (9.3%) | 0 (0.0%) | 1 (1.2%) | 24 (4.6%) |
Pneumothorax | 1 (0.6%) | 1 (0.7%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 2 (0.4%) |
Bolus | 1 (0.6%) | 1 (0.7%) | 1 (1.4%) | 0 (0.0%) | 0 (0.0%) | 1 (1.2%) | 4 (0.8%) |
Aspiration | 1 (0.6%) | 5 (3.4%) | 1 (1.4%) | 0 (0.0%) | 1 (4.5%) | 0 (0.0%) | 8 (1.5%) |
Airway bleeding | 4 (2.6%) | 3 (2.1%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 7 (1.3%) |
Neurological disease | 63 (40.9%) | 45 (30.8%) | 20 (27.1%) | 13 (30.2%) | 6 (27.3%) | 15 (17.9%) | 162 (31.0%) |
Stroke | 19 (12.3%) | 10 (6.8%) | 3 (4.1%) | 0 (0.0%) | 1 (4.5%) | 0 (0.0%) | 33 (6.3%) |
Seizure | 1 (0.6%) | 4 (2.7%) | 8 (10.8%) | 8 (18.6) | 4 (18.2%) | 9 (10.7%) | 34 (6.5%) |
Intracerebral bleeding | 18 (11.7%) | 11 (7.5%) | 4 (5.4%) | 4 (9.3%) | 0 (0.0%) | 2 (2.4%) | 39 (7.5%) |
Intoxication | 20 (13.0%) | 14 (9.6%) | 2 (2.7%) | 0 (0.0%) | 1 (4.5%) | 0 (0.0%) | 37 (7.1%) |
Unconsciousnessa | 5 (3.2%) | 4 (2.7%) | 2 (2.7%) | 1 (2.3%) | 0 (0.0%) | 4 (4.8%) | 16 (3.1%) |
Psychiatric disorder | 0 (0.0%) | 2 (1.4%) | 1 (1.4%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 3 (0.6%) |
Cardiovascular disease | 32 (20.8%) | 52 (35.6%) | 26 (35.3%) | 10 (23.2%) | 10 (45.4%) | 42 (50.0%) | 172 (32.9%) |
Pulmonary edema | 8 (5.2%) | 10 (6.8%) | 5 (6.8%) | 1 (2.3%) | 1 (4.5%) | 0 (0.0%) | 25 (4.8%) |
Congestive heart failure | 9 (5.8%) | 15 (10.3%) | 6 (8.1%) | 4 (9.3%) | 2 (9.1%) | 6 (7.1%) | 42 (8.0%) |
arhythmia | 0 (0.0%) | 7 (4.8%) | 2 (2.7%) | 0 (0.0%) | 1 (4.5%) | 1 (1.2%) | 11 (2.1%) |
Myocardial infarction | 6 (3.9%) | 13 (8.9%) | 7 (9.5%) | 4 (9.3%) | 3 (13.6%) | 13 (15.5%) | 46 (8.8%) |
Pulmonary embolism | 4 (2.6%) | 6 (4.1%) | 1 (1.4%) | 0 (0.0%) | 1 (4.5%) | 12 (14.3%) | 24 (4.6%) |
Aortic dissection | 3 (1.9%) | 1 (0.7%) | 3 (4.1%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 7 (1.3%) |
Cardiac arrest, unknown reason | 2 (1.3%) | 0 (0.0%) | 2 (2.7%) | 1 (2.3%) | 2 (9.1%) | 10 (11.9%) | 17 (3.3%) |
Gastrointestinal disease | 3 (1.9%) | 8 (5.5%) | 1 (1.4%) | 3 (7.0%) | 0 (0.0%) | 6 (7.1%) | 21 (4.0%) |
Lower GIB | 0 (0.0%) | 1 (0.7%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 1 (0.2%) |
Upper GIB | 2 (1.3%) | 5 (3.4%) | 1 (1.4%) | 3 (7.0%) | 0 (0.0%) | 5 (6.0%) | 16 (3.1%) |
RAAA | 1 (0.6%) | 2 (1.4%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 1 (1.2%) | 4 (0.8%) |
Others | 5 (3.2%) | 8 (5.5%) | 4 (5.5%) | 4 (9.3%) | 2 (9.1%) | 5 (6.0%) | 28 (5.4%) |
Drowning | 1 (0.6%) | 0 (0.0%) | 0 (0.0%) | 1 (2.3%) | 0 (0.0%) | 1 (1.2%) | 3 (0.6%) |
Hyperthermia | 0 (0.0%) | 1 (0.7%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 1 (0.2%) |
Hypothermia | 0 (0.0%) | 0 (0.0%) | 1 (1.4%) | 0 (0.0%) | 0 (0.0%) | 1 (1.2%) | 2 (0.4%) |
Exsiccosis | 0 (0.0%) | 1 (0.7%) | 0 (0.0%) | 0 (0.0%) | 1 (4.5%) | 0 (0.0%) | 2 (0.4%) |
Renal failure | 1 (0.6%) | 2 (1.4%) | 2 (2.7%) | 0 (0.0%) | 1 (4.5%) | 1 (1.2%) | 7 (1.3%) |
Other | 3 (1.9%) | 4 (2.7%) | 1 (1.4%) | 3 (7.0%) | 0 (0.0%) | 2 (1.4%) | 13 (2.5%) |
Admission lactate levels
Admission lactate level category (mmol/l) | |||||||
---|---|---|---|---|---|---|---|
0.0–1.9 | 2.0–3.9 | 4.0–5.9 | 6.0–7.9 | 8.0–9.9 | ≥10 | P | |
no. (%) | 154 (29.4%) | 146 (27.9%) | 74 (14.1%) | 43 (8.2%) | 22 (4.2%) | 84 (16.1%) | |
OR | 1 (Reference) | 1.24 | 1.35 | 2.02 | 2.83a | 7.56b | ap = 0,03; bp < 0.001 vs. reference |
95%CI | – | 0.73–2.10 | 0.72–2.53 | 0.98–4.16 | 1.13–7.11 | 4.18–13.77 | |
30-day mortality [n (%)] | 35 (22.7%) | 39 (26.7%) | 21 (28.4%) | 16 (37.2%) | 10 (45.5%) | 58 (69.0%) |
Admission lactate level category (mmol/l) | |||||||
---|---|---|---|---|---|---|---|
0.0–1.9 | 2.0–3.9 | 4.0–5.9 | 6.0–7.9 | 8.0–9.9 | ≥10 | all | |
no. (%) | 154 (29.4%) | 146 (27.9%) | 74 (14.1%) | 43 (8.2%) | 22 (4.2%) | 84 (16.1%) | 523 (100.0%) |
Adm. No MV | 125 (81.2%) | 116 (79.5%) | 56 (75.7%) | 36 (83.7%) | 10 (45.5%) | 22 (26.2%) | 365 (69.8%) |
SBP - mmHg | 148.2 ± 42.0 | 138.9 ± 37.7 | 130.6 ± 41.1 | 138.0 ± 48.5 | 119.7 ± 44.5 | 100.9 ± 40.5 | 138.4 ± 42.4 |
GCS | 10.9 ± 4.3 | 10.7 ± 4.4 | 11.1 ± 4.4 | 9.6 ± 4.7 | 8.9 ± 4.8 | 7.4 ± 4.4 | 10.5 ± 4.5 |
30 d mortality no. (%) | 30 (24.0%) | 31 (26.7%) | 16 (28.6%) | 8 (22.2%) | 1 (10.0%) | 5 (22.7%) | 91 (24.9%) |
Adm, MV | 29 (18.8%) | 30 (20.5) | 18 (24.3%) | 7 (16.3%) | 12 (54.5%) | 62 (73.8%) | 158 (30.2%) |
SBP - mmHg | 134.4 ± 38.4 | 128.2 ± 39.0 | 130.8 ± 47.3 | 107.0 ± 31.2 | 122.7 ± 54.1 | 115.6 ± 52.8 | 96.0 ± 38.0 |
GCS | 4.3 ± 3.1 | 3.3 ± 1.6 | 3.3 ± 1.2 | 3.0 ± 0.0 | 3.0 ± 0.0 | 3.0 ± 0.3 | 3.3 ± 1.6 |
30 d mortality no. (%) | 13 (44.8%) | 8 (26.7%) | 7 (38.9%) | 3 (42.9%) | 5 (41.7%) | 33 (53.2%) | 69 (43.7%) |