Home Association of prehospital lactate levels with base excess in various emergencies – a retrospective study
Article
Licensed
Unlicensed Requires Authentication

Association of prehospital lactate levels with base excess in various emergencies – a retrospective study

  • Michael Eichinger ORCID logo , Karan Shah , Niklas Palt , Michael Eichlseder , Alexander Pichler , Philipp Zoidl , Paul Zajic and Martin Rief EMAIL logo
Published/Copyright: February 20, 2024
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 62 Issue 8

Abstract

Objectives

Blood gas analysis, including parameters like lactate and base excess (BE), is crucial in emergency medicine but less commonly utilized prehospital. This study aims to elucidate the relationship between lactate and BE in various emergencies in a prehospital setting and their prognostic implications.

Methods

We conducted a retrospective analysis of prehospital emergency patients in Graz, Austria, from October 2015 to November 2020. Our primary aim was to assess the association between BE and lactate. This was assessed using Spearman’s rank correlation and fitting a multiple linear regression model with lactate as the outcome, BE as the primary covariate of interest and age, sex, and medical emergency type as confounders.

Results

In our analysis population (n=312), lactate and BE levels were inversely correlated (Spearman’s ρ, −0.75; p<0.001). From the adjusted multiple linear regression model (n=302), we estimated that a 1 mEq/L increase in BE levels was associated with an average change of −0.35 (95 % CI: −0.39, −0.30; p<0.001) mmol/L in lactate levels. Lactate levels were moderately useful for predicting mortality with notable variations across different emergency types.

Conclusions

Our study highlights a significant inverse association between lactate levels and BE in the prehospital setting, underscoring their importance in early assessment and prognosis in emergency care. Additionally, the findings from our secondary aims emphasize the value of lactate in diagnosing acid–base disorders and predicting patient outcomes. Recognizing the nuances in lactate physiology is essential for effective prehospital care in various emergency scenarios.

Keywords: emergency medical services; blood gas analysis; lactic acid; acid–base imbalance
Corresponding author: Martin Rief, MD, PhD, Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria, E-mail:

  1. Research ethics: The local Institutional Review Board reviewed the study protocol and approved it (33-317 ex20/21, Ethics Committee of the Medical University Graz, Austria).

  2. Informed consent: Not applicable.

  3. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: The authors state no conflict of interest.

  5. Research funding: None declared.

References

1. Zwisler, ST, Zincuk, Y, Bering, CB, Zincuk, A, Nybo, M, Mikkelsen, S. Diagnostic value of prehospital arterial blood gas measurements - a randomised controlled trial. Scand J Trauma Resusc Emerg Med 2019;27:1–9. https://doi.org/10.1186/s13049-019-0612-8.Search in Google Scholar PubMed PubMed Central

2. Wardi, G, Brice, J, Correia, M, Liu, D, Self, M, Tainter, C. Demystifying lactate in the emergency department. Ann Emerg Med [Internet] 2020;75:287–98. https://doi.org/10.1016/j.annemergmed.2019.06.027.Search in Google Scholar PubMed

3. Kruse, O, Grunnet, N, Barfod, C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med 2011;19:5–8. https://doi.org/10.1186/1757-7241-19-74.Search in Google Scholar PubMed PubMed Central

4. Kraut, JA, Madias, NE. Lactic acidosis. N Engl J Med, 2014 371:2309–19.10.1056/NEJMra1309483Search in Google Scholar PubMed

5. Garcia-alvarez, M, Marik, P, Bellomo, R. Sepsis-associated hyperlactatemia. Crit Care 2014;18:503. https://doi.org/10.1186/s13054-014-0503-3.Search in Google Scholar PubMed PubMed Central

6. Brooks, GA. Lactate as a fulcrum of metabolism. Redox Biol 2020;35:101454. https://doi.org/10.1016/j.redox.2020.101454.Search in Google Scholar PubMed PubMed Central

7. Gladden, LB. Lactate metabolism: a new paradigm for the third millennium. J Physiol 2004;558:5–30. https://doi.org/10.1113/jphysiol.2003.058701.Search in Google Scholar PubMed PubMed Central

8. Lee, TY. Lactate: a multifunctional signaling molecule. Yeungnam Univ J Med 2021;38:183–93.10.12701/yujm.2020.00892Search in Google Scholar PubMed PubMed Central

9. Baxter, J, Cranfield, KR, Clark, G, Harris, T, Bloom, B, Gray, AJ. Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review. J Trauma Acute Care Surg 2016;81:555–66. https://doi.org/10.1097/ta.0000000000001156.Search in Google Scholar

10. Bhat, SR, Swenson, KE, Francis, MW, Wira, CR. Lactate clearance predicts survival among patients in the emergency department with severe sepsis. West J Emerg Med 2015;16:1118–26. https://doi.org/10.5811/westjem.2015.10.27577.Search in Google Scholar PubMed PubMed Central

11. Van Beest, PA, Mulder, PJ, Oetomo, SB, Van Den Broek, B, Kuiper, MA, Spronk, PE. Measurement of lactate in a prehospital setting is related to outcome. Eur J Emerg Med 2009;16:318–22. https://doi.org/10.1097/mej.0b013e32832dbe54.Search in Google Scholar PubMed

12. Siggaard-Andersen, O, Fogh-Andersen, N. Base excess or buffer base (strong ion difference) as measure of a non-respiratory acid–base disturbance. Acta Anaesthesiol Scand 1995;39:123–8. https://doi.org/10.1111/j.1399-6576.1995.tb04346.x.Search in Google Scholar PubMed

13. Husain, FA, Martin, MJ, Mullenix, PS, Steele, SR, Elliott, DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg 2003;185:485–91. https://doi.org/10.1016/s0002-9610(03)00044-8.Search in Google Scholar PubMed

14. Zhang, Z, Xu, X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically Ill patients: a systematic review and meta-analysis. Crit Care Med 2014;42:2118–25. https://doi.org/10.1097/ccm.0000000000000405.Search in Google Scholar PubMed

15. Davis, JW, Dirks, RC, Kaups, KL, Tran, P. Base deficit is superior to lactate in trauma. Am J Surg 2018;215:682–5. https://doi.org/10.1016/j.amjsurg.2018.01.025.Search in Google Scholar PubMed

16. Raux, M, Le Manach, Y, Gauss, T, Baumgarten, R, Hamada, S, Harrois, A, et al.. Comparison of the prognostic significance of initial blood lactate and base deficit in trauma patients. Anesthesiology 2017;126:522–33. https://doi.org/10.1097/aln.0000000000001490.Search in Google Scholar PubMed

17. von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC, Vandenbroucke, JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008;61:344–9. https://doi.org/10.1016/j.jclinepi.2007.11.008.Search in Google Scholar PubMed

18. Schwartz, WB, Relman, AS. A critique of the parameters used in the evaluation of acid–base disorders. N Engl J Med 1963;268:1382–8. https://doi.org/10.1056/nejm196306202682503.Search in Google Scholar PubMed

19. R Core Team. R. A language and environment for statistical computing. [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2020 [cited 2022 Aug 4]. Available from: https://www.R-project.org/.Search in Google Scholar

20. Robergs, RA, Ghiasvand, F, Parker, D. Biochemistry of exercise-induced metabolic acidosis. Am J Physiol Regul Integr Comp Physiol 2004;287:502–16. https://doi.org/10.1152/ajpregu.00114.2004.Search in Google Scholar PubMed

21. Bellomo, R, Kellum, JA, Pinsky, MR. Transvisceral lactate fluxes during early endotoxemia. Chest 1996;110:198–204. https://doi.org/10.1378/chest.110.1.198.Search in Google Scholar PubMed

22. Momiyama, Y, Yamada, W, Miyata, K, Miura, K, Fukuda, T, Fuse, J, et al.. Prognostic values of blood pH and lactate levels in patients resuscitated from out-of-hospital cardiac arrest. Acute Med Surg 2017;4:25–30. https://doi.org/10.1002/ams2.217.Search in Google Scholar PubMed PubMed Central

23. Williams, TA, Martin, R, Celenza, A, Bremner, A, Fatovich, D, Krause, J, et al.. Use of serum lactate levels to predict survival for patients with out-of-hospital cardiac arrest: a cohort study. Emerg Med Australasia 2016;28:171–8. https://doi.org/10.1111/1742-6723.12560.Search in Google Scholar PubMed

24. Laurikkala, J, Skrifvars, MB, Bäcklund, M, Tiainen, M, Bendel, S, Karhu, J, et al.. Early lactate values after out-of-hospital cardiac arrest: associations with one-year outcome. Shock 2019;51:168–73. https://doi.org/10.1097/shk.0000000000001145.Search in Google Scholar

25. Prause, G, Ratzenhofer-Comenda, B, Smolle-Jüttner, F, Heydar-Fadai, J, Wildner, G, Spernbauer, P, et al.. Comparison of lactate or BE during out-of-hospital cardiac arrest to determine metabolic acidosis. Resuscitation 2001;51:297–300. https://doi.org/10.1016/s0300-9572(01)00424-5.Search in Google Scholar PubMed

26. Park, M, Sidebotham, D. Metabolic alkalosis and mixed acid-base disturbance in anaesthesia and critical care. BJA Educ 2023;23:128–35. https://doi.org/10.1016/j.bjae.2023.01.002.Search in Google Scholar PubMed PubMed Central

27. Lentz, SA, Ackil, D. Metabolic acid–base disorders. Emerg Med Clin North Am 2023;41:849–62. https://doi.org/10.1016/j.emc.2023.06.008.Search in Google Scholar PubMed

28. Lewis, LM, Ferguson, I, House, SL, Aubuchon, K, Schneider, J, Johnson, K, et al.. Albuterol administration is commonly associated with increases in serum lactate in patients with asthma treated for acute exacerbation of asthma. Chest 2014;145:53–9. https://doi.org/10.1378/chest.13-0930.Search in Google Scholar PubMed

29. Doğan, EA, Ünal, A, Ünal, A, Erdoğan, Ç. Clinical utility of serum lactate levels for differential diagnosis of generalized tonic–clonic seizures from psychogenic nonepileptic seizures and syncope. Epilepsy Behav 2017;75:13–7. https://doi.org/10.1016/j.yebeh.2017.07.003.Search in Google Scholar PubMed

30. Matz, O, Zdebik, C, Zechbauer, S, Bündgens, L, Litmathe, J, Willmes, K, et al.. Lactate as a diagnostic marker in transient loss of consciousness. Seizure 2016;40:71–5. https://doi.org/10.1016/j.seizure.2016.06.014.Search in Google Scholar PubMed

31. Evans, L, Rhodes, A, Alhazzani, W, Antonelli, M, Coopersmith, CM, French, C, et al.. Surviving sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med 2021;49:e1063–143. https://doi.org/10.1097/ccm.0000000000005337.Search in Google Scholar PubMed

32. Vincent, JL, Bakker, J. Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care 2021;27:298–302. https://doi.org/10.1097/mcc.0000000000000824.Search in Google Scholar

33. Lewis, CT, Naumann, DN, Crombie, N, Midwinter, MJ. Prehospital point-of-care lactate following trauma: a systematic review. J Trauma Acute Care Surg 2016;81:748–55. https://doi.org/10.1097/ta.0000000000001192.Search in Google Scholar

Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2024-0060).

Received: 2022-11-01
Accepted: 2024-02-08
Published Online: 2024-02-20
Published in Print: 2024-07-26

© 2024 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Analytical performance specifications – moving from models to practical recommendations
  4. Opinion Papers
  5. What the Milan conference has taught us about analytical performance specification model definition and measurand allocation
  6. The role of analytical performance specifications in international guidelines and standards dealing with metrological traceability in laboratory medicine
  7. How clinical laboratories select and use Analytical Performance Specifications (APS) in Italy
  8. Outcome-based analytical performance specifications: current status and future challenges
  9. Analytical performance specifications based on biological variation data – considerations, strengths and limitations
  10. State-of-the-art model for derivation of analytical performance specifications: how to define the highest level of analytical performance technically achievable
  11. Analytical performance specifications for combined uncertainty budget in the implementation of metrological traceability
  12. When bias becomes part of imprecision: how to use analytical performance specifications to determine acceptability of lot-lot variation and other sources of possibly unacceptable bias
  13. Using analytical performance specifications in a medical laboratory
  14. Issues in assessing analytical performance specifications in healthcare systems assembling multiple laboratories and measuring systems
  15. Applying the Milan models to setting analytical performance specifications – considering all the information
  16. Guidelines and Recommendations
  17. Recommendations for blood sampling in emergency departments from the European Society for Emergency Medicine (EUSEM), European Society for Emergency Nursing (EuSEN), and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase. Executive summary
  18. General Clinical Chemistry and Laboratory Medicine
  19. Assessment of accuracy of laboratory testing results, relative to peer group consensus values in external quality control, by bivariate z-score analysis: the example of D-Dimer
  20. The stability of 65 biochemistry analytes in plasma, serum, and whole blood
  21. Assessment of the 2023 European Kidney Function Consortium (EKFC) equations in a Chinese adult population
  22. In vitro, in vivo metabolism and quantification of the novel synthetic opioid N-piperidinyl etonitazene (etonitazepipne)
  23. Quantification of blood glial fibrillary acidic protein using a second-generation microfluidic assay. Validation and comparative analysis with two established assays
  24. Association of prehospital lactate levels with base excess in various emergencies – a retrospective study
  25. Reference Values and Biological Variations
  26. Stability of ten serum tumor markers after one year of storage at −18°C
  27. Variations in tumor growth, intra-individual biological variability, and the interpretation of changes
  28. Cancer Diagnostics
  29. N-linked glycosylation of the M-protein variable region: glycoproteogenomics reveals a new layer of personalized complexity in multiple myeloma
  30. Cardiovascular Diseases
  31. Reference intervals for high sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide in children and adolescents on the Siemens Atellica
  32. Infectious Diseases
  33. Fetal chronic hypoxia does not affect urinary presepsin levels in newborns at birth
  34. Letters to the Editor
  35. AWMF statement on medical services in laboratory diagnostics and pathology with regard to the IVDR
  36. An outline of measurement uncertainty of total protein in urine estimated according to the ISO Technical Specification 20914
  37. Early diagnosis of severe illness in an outpatient – the Sysmex XN’s neutrophil reactivity parameter
  38. Analytical and diagnostic performance of Theradiag i-Tracker assays on IDS-iSYS for infliximab and adalimumab therapeutic drug monitoring
  39. Improving the diagnosis of AATD with aid of serum protein electrophoresis: a prospective, multicentre, validation study
  40. Cerebrospinal fluid kappa free light chains in patients with tumefactive demyelination
  41. Diagnostic value of quantitative chemiluminescence immunoassay for anti-gp210 and anti-sp100 antibodies in primary biliary cholangitis
https://doi.org/10.1515/cclm-2024-0060
Keywords for this article
emergency medical services; blood gas analysis; lactic acid; acid–base imbalance

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Analytical performance specifications – moving from models to practical recommendations
  4. Opinion Papers
  5. What the Milan conference has taught us about analytical performance specification model definition and measurand allocation
  6. The role of analytical performance specifications in international guidelines and standards dealing with metrological traceability in laboratory medicine
  7. How clinical laboratories select and use Analytical Performance Specifications (APS) in Italy
  8. Outcome-based analytical performance specifications: current status and future challenges
  9. Analytical performance specifications based on biological variation data – considerations, strengths and limitations
  10. State-of-the-art model for derivation of analytical performance specifications: how to define the highest level of analytical performance technically achievable
  11. Analytical performance specifications for combined uncertainty budget in the implementation of metrological traceability
  12. When bias becomes part of imprecision: how to use analytical performance specifications to determine acceptability of lot-lot variation and other sources of possibly unacceptable bias
  13. Using analytical performance specifications in a medical laboratory
  14. Issues in assessing analytical performance specifications in healthcare systems assembling multiple laboratories and measuring systems
  15. Applying the Milan models to setting analytical performance specifications – considering all the information
  16. Guidelines and Recommendations
  17. Recommendations for blood sampling in emergency departments from the European Society for Emergency Medicine (EUSEM), European Society for Emergency Nursing (EuSEN), and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase. Executive summary
  18. General Clinical Chemistry and Laboratory Medicine
  19. Assessment of accuracy of laboratory testing results, relative to peer group consensus values in external quality control, by bivariate z-score analysis: the example of D-Dimer
  20. The stability of 65 biochemistry analytes in plasma, serum, and whole blood
  21. Assessment of the 2023 European Kidney Function Consortium (EKFC) equations in a Chinese adult population
  22. In vitro, in vivo metabolism and quantification of the novel synthetic opioid N-piperidinyl etonitazene (etonitazepipne)
  23. Quantification of blood glial fibrillary acidic protein using a second-generation microfluidic assay. Validation and comparative analysis with two established assays
  24. Association of prehospital lactate levels with base excess in various emergencies – a retrospective study
  25. Reference Values and Biological Variations
  26. Stability of ten serum tumor markers after one year of storage at −18°C
  27. Variations in tumor growth, intra-individual biological variability, and the interpretation of changes
  28. Cancer Diagnostics
  29. N-linked glycosylation of the M-protein variable region: glycoproteogenomics reveals a new layer of personalized complexity in multiple myeloma
  30. Cardiovascular Diseases
  31. Reference intervals for high sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide in children and adolescents on the Siemens Atellica
  32. Infectious Diseases
  33. Fetal chronic hypoxia does not affect urinary presepsin levels in newborns at birth
  34. Letters to the Editor
  35. AWMF statement on medical services in laboratory diagnostics and pathology with regard to the IVDR
  36. An outline of measurement uncertainty of total protein in urine estimated according to the ISO Technical Specification 20914
  37. Early diagnosis of severe illness in an outpatient – the Sysmex XN’s neutrophil reactivity parameter
  38. Analytical and diagnostic performance of Theradiag i-Tracker assays on IDS-iSYS for infliximab and adalimumab therapeutic drug monitoring
  39. Improving the diagnosis of AATD with aid of serum protein electrophoresis: a prospective, multicentre, validation study
  40. Cerebrospinal fluid kappa free light chains in patients with tumefactive demyelination
  41. Diagnostic value of quantitative chemiluminescence immunoassay for anti-gp210 and anti-sp100 antibodies in primary biliary cholangitis
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 8.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2024-0060/html
Scroll to top button