PMID- 34343760
OWN - NLM
STAT- MEDLINE
DCOM- 20211220
LR  - 20211220
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 50
DP  - 2021 Dec
TI  - Prognostic utility of lactate concentrations and kinetics to predict adverse 
      events associated with acute drug overdose.
PG  - 120-125
LID - S0735-6757(21)00591-X [pii]
LID - 10.1016/j.ajem.2021.07.025 [doi]
AB  - OBJECTIVE: Clinical research on drug intoxication is necessary for appropriate 
      action in emergency departments (EDs). However, currently, there are no evident 
      biomarkers for predicting adverse events (AEs) in patients with drug 
      intoxication. We aimed to evaluate the prognostic value of serum lactate 
      concentrations and lactate kinetics for AEs such as cardiogenic or respiratory 
      failure in patients admitted to the ED with acute drug overdose. METHODS: We 
      conducted a single-center retrospective study by reviewing the prospective 
      suicide registry of patients visiting the ED. The primary outcome was composite 
      AEs at any point during the ED visit or hospital stay. RESULTS: A total of 566 
      patients with acute drug overdose were enrolled in this study. Of these, 62 
      patients had AEs, whereas 363 patients did not, yielding an AE rate of 14.6%. The 
      median 0 h lactate concentrations in the AE and non-AE groups were 2.7 [2.1-5.1] 
      mmol/L and 2.1 [1.4-2.9] mmol/L, respectively (p < 0.001). The median 6 h lactate 
      concentrations in the AE and non-AE groups were 2.0 [1.5-3.9] mmol/L and 1.3 
      [0.9-2.2] mmol/L, respectively (p < 0.001). The area under the curve of lactate 
      at 0 h for predicting AEs was 0.705 (95% CI: 0.659-0.748). The optimal lactate 
      cutoff point was 4.2 mmol/L (37.1% sensitivity, 92.8% specificity). Multivariable 
      analysis using a stepwise backward method showed that the 0 h lactate 
      concentration was associated with AEs in acute drug intoxication after adjusting 
      for confounders (adjusted OR of 0 h lactate, 1.47; 95% CI, 1.23-1.77). However, 
      the 6 h lactate concentrations, lactate clearance, and delta lactate levels did 
      not predict the outcomes. CONCLUSION: Lactate concentrations and kinetics in 
      patients admitted to the ED with an acute drug overdose exhibited limited 
      prognostic utility in predicting AEs and should be interpreted with caution when 
      considered for clinical decision-making.
CI  - Copyright (c) 2021 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Kim, Sung Jin
AU  - Kim SJ
AD  - Department of Emergency Medicine, Korea University Ansan Hospital, Anasn, 
      Republic of Korea.
FAU - Cho, Hanjin
AU  - Cho H
AD  - Department of Emergency Medicine, Korea University Ansan Hospital, Anasn, 
      Republic of Korea.
FAU - Ahn, Sejoong
AU  - Ahn S
AD  - Department of Emergency Medicine, Korea University Ansan Hospital, Anasn, 
      Republic of Korea.
FAU - Kim, Joo Yeong
AU  - Kim JY
AD  - Department of Emergency Medicine, Korea University Ansan Hospital, Anasn, 
      Republic of Korea.
FAU - Song, Juhyun
AU  - Song J
AD  - Department of Emergency Medicine, Korea University Ansan Hospital, Anasn, 
      Republic of Korea.
FAU - Park, Jong-Hak
AU  - Park JH
AD  - Department of Emergency Medicine, Korea University Ansan Hospital, Anasn, 
      Republic of Korea. Electronic address: roadrunner@korea.ac.kr.
LA  - eng
PT  - Journal Article
DEP - 20210726
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
RN  - 0 (Lactates)
SB  - IM
MH  - Adult
MH  - Drug Overdose/*blood
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - Lactates/*blood/pharmacokinetics
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Registries
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Drug
OT  - Intoxication
OT  - Lactate
OT  - Overdose
COIS- Declaration of Competing Interest The authors declare no potential conflicts of 
      interest with respect to the research, authorship, and/or publication of this 
      article.
EDAT- 2021/08/04 06:00
MHDA- 2021/12/21 06:00
CRDT- 2021/08/03 20:18
PHST- 2021/05/26 00:00 [received]
PHST- 2021/07/13 00:00 [revised]
PHST- 2021/07/17 00:00 [accepted]
PHST- 2021/08/04 06:00 [pubmed]
PHST- 2021/12/21 06:00 [medline]
PHST- 2021/08/03 20:18 [entrez]
AID - S0735-6757(21)00591-X [pii]
AID - 10.1016/j.ajem.2021.07.025 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2021 Dec;50:120-125. doi: 10.1016/j.ajem.2021.07.025. Epub 2021 
      Jul 26.