Point-of-care lactate testing for sepsis at presentation to health care: a systematic review of patient outcomes

Background: Lactate is measured in hospital settings to identify patients with sepsis and severe infections, and guide initiation of early treatment. Point-of-care technology could facilitate measurement of lactate by first contact clinicians in the community, however there has been little research into its utility in these environments.andnbsp; Aim: To investigate the effect of using point-of-care lactate (at presentation to healthcare) on mortality and other clinical outcomes, in patients presenting with acute infections. Design and Setting: Studies comparing the use of point-of-care lactate testing to usual care in initial patient assessment at presentation to healthcare, were identified using a maximally sensitive search strategy of six electronic databases. Methods: Two independent authors screened 3640 records for eligibility, and extracted data from eligible studies.andnbsp; Quality assessment for observational studies was performed using the ROBINS-I tool.andnbsp; Results: 8 studies were eligible for inclusion (3161 patients).andnbsp; Seven studies recruited from emergency departments and one from a pre-hospital aeromedical setting. Five studies demonstrated a trend towards reduced mortality with point-of-care lactate testing; three studies achieved statistical significance.andnbsp; One study demonstrated a significant reduction in length of hospital stay, although another did not find any significant difference.andnbsp; Two studies demonstrated a significant reduction in time to treatment for antibiotics and intravenous fluids. Conclusion: There is no high quality evidence to support the use of point-of-care lactate in community settings.andnbsp; However, the available evidence suggests a trend towards reduction in in-hospital mortality associated with point-of-care lactate testing.andnbsp; RCT evidence from community settings is required to evaluate this potentially beneficial diagnostic technology. Systematic Review Registration Number: CRD42017046052