Lactate Use as Triage Tool in Sepsis : Veinous, Capillary or Arterial?

Study Overview
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Brief Summary
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Severe sepsis and septic shocks are increasingly codified. A biomarker as Lactate is very interesting to detect those situations. Usually, lactate used is arterial but results are often too slow to obtain if we want to respect Surviving Sepsis Campaign guidelines. Some analyzers (EKF diagnostics Lactate Scout*) can give results in 15 seconds. We hypothesized that capillary lactate, easy to sample, tested with this analyzer may detect earlier those infections states and we want to find the most accurate site to detect severe sepsis (capillary, venous or arterial sample).

Detailed Description
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Actually, patients presenting a sepsis with arterial lactate> 2 mmol.l-1 must be considered as criticals, and if lactate> 4 mmol.l-1 as septic shock. However, results are usually slow to obtain, especially if we want to respect the Surving Sepsis Campaign, which preconize antibiotic as soon as possible (first hour). In admission room, arterial sample can't be easily done and usual results need more than 30 minutes. On the contrary, using analyzers like EKF diagnostics Lactate Scout* can give results faster with capillary blood (15 seconds). We will compare this results with both veinous and arterial lactate. For primary outcome, we will determine the most accurate value of capillary or veinous lactate that may be able to detect critical patient suspected of infection. for secondary outcomes, we will determine if quick capillary lactate test may replace arterial lactate in this indication and be able to predict mortality.

Official Title
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Lactate and Sepsis : What Dosage Use as Triage Tool in Emergency Department for Patients With Suspected Infection.

Conditions
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Sepsis

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age >18 years S.I.R.S : 2 or more criteria (fever > 38.3°C or hypothermia (core temperature < 36°C) heart rate > 90.min-1, tachypnea, altered mental status) Suspected infection Exclusion Criteria: Arterial sample by laboratory reference method no available

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lactate value | Determine the most accurate value of capillary or venous lactate that may be able to early detect patients with severe sepsis or septic shock, using quick test (EKF diagnostics Lactate scout*). | At admission in emergency department | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison values of capillary lactate and arterial lactate | Determine if capillary blood lactate may replace laboratory reference method (arterial lactate) | 30 minutes after sampling | 
| Mortality | Determine if capillary lactate value can be use as a mortality predictive tool | Day 28 mortality | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lactate, Sepsis, Capillary lactate, Venous lactate, Quick test