Lactate and combined parameters for triaging sepsis patients into intensive care facilities

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Purpose:To find predictors of intensive care unit (ICU) requirement within the first 48 hours in newly diagnosed sepsis patients presenting at the emergency department.Materials and methods:Analysis of a prospective observational cohort was performed. We recruited new sepsis patients at the emergency department, and collected baseline characteristics and parameters. Variables were compared between patients: those that required ICU within 48 hours and those that did not. Multivariate analysis was performed to identify independent predictors.Results:Out of 719 patients enrolled, 275 were confirmed to have sepsis. There were 107 patients (39%) that required ICU admission within 48 hours. Independent predictors for ICU requirement were: lower body temperature (P = .019), initial lactate (P = .02), 2-hour lactate clearance (P = .035), and the Sequential Organ Failure Assessment (SOFA) score without cardiovascular component (SOFA no CVS) (P < .001). The optimal cutoff values for the two strongest predictors were: SOFA no CVS ≥ 5 (adjusted OR, 5.3; 95% CI, 1.9–14.7) and initial lactate ≥ 1.9 mmol/L (adjusted OR, 3.3; 95% CI, 1.2–8.9). We also proposed a combined “LACTIC score” with higher predictive ability.Conclusions:We suggested a way to predict ICU requirement in sepsis patients and proposed a combined score that might be better than individual parameters. Further validation should be performed before using them clinically.

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