Prognostic value of lactate and qSOFA score in acute drug overdose patients in ED = Prognostic value of lactate and qSOFA score in acute drug overdose patients in ED

다국어 초록 (Multilingual Abstract)

Introduction
There are currently no existing biomarkers or clinical risk scores proven to predict mortality in drug overdose patients. The initial lactate had excellent prognostic utility for the occurrence of both shock and fatality. However, the prognostic utility of lactate in the initial evaluation of drug overdose in the ED is controversial. We aimed to evaluate the prognostic value of lactate for adverse events in ED patients with an acute drug overdose. Moreover, we investigated whether the combination of lactate and qSOFA is a better prognostic predictor than lactate alone.
Material & Method
We conducted a retrospective analysis of a prospective observational suicide registry. Patients aged over 15 years who had acute drug overdose in the ED from January 1st, 2017 to December 31st, 2019 were enrolled. Using data from the suicide registry of our institution, we retrospectively retrieved data. The primary outcome was adverse events at any point during the ED or hospital stay. Adverse events were defined as follows: any vasopressors use, high-flow or ventilator care, AKI, toxic hepatitis, and severe rhabdomyolysis.
Result
During the study period, of patients screened, 531 were analyzed (mean age 40.4 years) and 62 had adverse events (11.7%). Mean lactate concentration (mmol/L) was 3.6 ± 2.6 for adverse event group and 2.3 ± 1.4 for non-adverse event group (p < 0.001). The AUC of lactate for the prediction of adverse events was 0.684 (95% CI: 0.569?0.726). The optimal lactate cut point for adverse events was 5.0 mmol/L (32.3% sensitivity, 93.0% specificity). The AUC of lactate with qSOFA score was 0.755 (95% CI: 0.686?0.825). The optimal cut-points of lactate with qSOFA were 1 point and 4.0 mmol/L, respectively (53.2% sensitivity, 85.7%). Multivariable analysis showed that lactate and qSOFA score were independent risk factors for adverse events of the acute drug overdose patients (aOR of lactate 1.32, 95%CI,1.14-1.52; aOR of qSOFA 2.60, 95%CI, 1.80-3.82).
Conclusion
This is the first study to assess the prognostic value of a combination of lactate concentration and qSOFA score in patients with an acute drug overdose. Our results suggest that lactate concentration can be a useful biomarker for clinical decision making in ED patients with an acute drug overdose. Moreover, a combination of lactate and qSOFA is had an excellent prognostic utility to predict adverse events for drug overdose patients than lactate alone.