Serum lactate level potential predictor for ICU admissions in patients presenting with seizure at ED: Study

A recent study published in the journal of Internal and Emergency Medicine highlighted the significance of serum lactate levels as a potential predictor for intensive care unit (ICU) admission in patients presenting with seizures at the emergency department (ED). This retrospective cohort study looked forward to fill a gap in existing research by assessing if serum lactate could help foresee the need for ICU care in these patients.

The study analyzed the records of 288 adult patients, all aged 18 or older, who were diagnosed with seizures or convulsive status epilepticus at the ED and had their serum venous lactate levels tested. Out of this group, 45 patients (15.63%) required admission to the ICU. The primary goal was to identify clinical factors that were independently predictive of such admissions.

The research employed logistic regression analysis to assess the data and identify predictors. 2 main factors were found to be significant indicators for ICU admission:

• Convulsive Status Epilepticus: The patients presenting with this severe form of seizure were found to be at notably higher risk for ICU admission, with an adjusted odds ratio of 4.793 (95% confidence interval: 2.119, 10.844).
• Serum Lactate Levels: Elevated serum lactate levels also correlated with increased likelihood of ICU admission. For every 1 mg/dL increase in serum lactate, the adjusted odds ratio was 1.008 (95% confidence interval: 1.001, 1.016).

The study determined that a serum lactate threshold of over 63 mg/dL provided a specificity of 80.25% for predicting ICU admissions, despite the sensitivity being lower at 35.56%. The area under the receiver operating characteristic (ROC) curve was calculated at 63.30% (with a 95% confidence interval ranging from 54.77% to 71.84%) which indicated moderate predictive performance.

These findings suggest that serum lactate could serve as a practical, early marker for evaluating the need for more intensive monitoring and treatment in seizure patients at the ED. The high specificity associated with a lactate level over 63 mg/dL meant that while the marker is less sensitive and it is reliable in ruling in the need for ICU care when elevated. Also, convulsive status epilepticus remains a significant factor necessitating critical intervention. Overall, the results from this study highlight the utility of serum lactate as part of the broader assessment strategy for ED patients who were presenting with seizures.

Reference:

Phungoen, P., Khamsai, S., Chotmongkol, V., Daungjunchot, R., Sawanyawisuth, K., & Tangpaisarn, T. (2024). Serum lactate is associated with an ICU admission in patients presenting with seizure at the emergency department. In Internal and Emergency Medicine. Springer Science and Business Media LLC. https://doi.org/10.1007/s11739-024-03806-1