Delayed Detection of Excessive Lactate Levels in Sepsis Patients Makes Hospital Deaths More Likely

Delayed Detection of Excessive Lactate Levels in Sepsis Patients Makes Hospital Deaths More LikelyStatistics from the Centers for Disease Control & Prevention (CDC) indicate that 1.5 million cases of sepsis occur each year in the U.S. Among these, about 250,000 Americans die annually as a result of this inflammatory response of the body to infection.

Diagnosing sepsis in its early stages is critical to the successful recovery of the sepsis patient. In particular, diagnosing the lactate levels in a sepsis patient is highly consequential to the patient’s outcome. A failure to properly diagnose or diagnose promptly can lead to a tragic outcome.

Care bundles for sepsis treatment

The increasing occurrence of sepsis, a leading reason for deaths that occur in hospital, has motivated the Centers for Medicare and Medicaid Services (CMS) to establish specific types of protocols referred to as care bundles. These care bundles are designed to implement standards that govern the care of sepsis patients with the intent of improving the quality of that care. There is a known link between elevated levels of lactose and mortality rates, and due to this connection, the protocols require medical personnel to test lactate levels as soon as possible after the diagnosis of sepsis.

Study reveals pervasive delays in sepsis patient lactate measurements

Published in the Journal CHEST®, a new study reveals that a substantial percentage of patients who are suspected of having contracted sepsis are not tested for lactate levels within the recommended timeframe. The same patients experienced delays in IV fluid administration and antibiotic therapy. They were also subjected to an enhanced risk of death in-hospital.

Dr. Xuan Han of the University of Chicago along with fellow colleagues conducted an evaluation concerning the consequences of the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) regarding patient care and associated outcomes for adults received into a single tertiary care academic hospital from Nov. 2008 to Jan. 2016.

The evaluation included an analysis of each patient, including vital signs, characteristics, lab measurements, and medical therapy. The focus was particularly on measuring lactate levels.

Regarding the objective of the study, Han states, “Sepsis continues to be a major public health problem in the US, one with persistently high mortality despite continued efforts to improve care. Our goal with this study was to better understand, on a more granular level, how sepsis bundles affect the patients we apply them to.”

One of the recommendations of the SEP-1 guidelines presented in 2015 involves the measurement of serum lactate six hours prior and three hours post sepsis presentation. Additionally, if the initial lactate measurement is elevated another measurement is to take place within six hours of presentation.

“Patients with early lactate measurements received earlier interventions such as antibiotic administration, which is known to improve mortality in sepsis,” states Matthew M. Churpek, MD, MPH, PhD, of the Department of Medicine and Center for Healthcare Delivery, Science and Innovation at the University of Chicago.

Of the 5,762 admissions falling into the SEP-1 criteria for severe sepsis within six hours of presentation, only six out of 10 received an initial lactate measurement within the required time frame. Fourteen percent had measurements taken between three and 24 hours after first possible detection of sepsis and more than 25% had no measurements taken.

Location of treatment a significant factor in prompt lactate measurements

Dr. Churpek comments that this study demonstrated that a significant number of patients acquire sepsis in hospital wards. “This is an important population of patients in which to effectively prepare identify and treat sepsis,” he said.

The location where the treatment was provided to the patient also determined the level of promptness in measuring lactate levels. For instance, 79% of emergency room patients had their levels measured within the SEP-1 specified time. This compares with 55% of patients in intensive care units (ICUs) and 32% of patients in hospital wards.

Patient mortality rates also coincide with degree of initial lactate levels

The degree of lactate levels also corresponded with mortality rates. ICU patients with normal initial lactate levels suffered a 35% mortality rate as opposed to a 62% mortality rate with initial elevated lactate levels. As well, for a particular patient with elevated lactate levels at the first draw, every hour of delayed lactate measurement corresponded to a 2% greater chance of death for that patient occurring in-hospital. As compared with patients who have lactate measurements within the designated SEP-1 timeframe, those with delayed lactate measurements had to wait three times as long to receive fluids and two times as long to receive antibiotics.

As Dr. Churpek notes, “Systematic early lactate measurements when a patient presents with sepsis may thus be useful in prompting earlier, potentially life-saving interventions.”

At McGowan, Hood, Felder & Phillips, LLC, we understand the trauma and devastation you may be experiencing in the wake of an injury caused by medical negligence or malpractice. You can count on our extensive experience handling cases successfully for our clients that involved sepsis and other severe medical issues. We are here to fight for the compensation you deserve due to your injuries. To set up a free case review with an experienced medical malpractice lawyer, please call 803-327-7800 or fill out our contact form.