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Original Research

Open Access

Should lactate levels be combined with rapid emergency medicine scores (REMS) to predict outcomes of patients with dyspnea

  • Pınar Vargun1
  • Sarper Yilmaz2,*,
  • Ali Cankut Tatliparmak3
  • Ozgur Karcioglu4

1Department of Emergency Medicine, Zonguldak Ataturk State Hospital, 67100 Zonguldak, Turkey

2Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, 34865 Istanbul, Turkey

3Department of Emergency Medicine, Kolan International Hospital, 34384 Istanbul, Turkey

4Department of Emergency Medicine, University of Health Sciences, Taksim Education and Research Hospital, 34421 Istanbul, Turkey

DOI: 10.22514/sv.2023.024 Vol.19,Issue 5,September 2023 pp.161-168

Submitted: 28 October 2022 Accepted: 12 January 2023

Published: 08 September 2023

*Corresponding Author(s): Sarper Yilmaz E-mail:


This study analyzes the effectiveness of adding lactate levels to the Rapid Emergency Medicine Score (REMS) scoring system to better predict short-term mortality and outcomes in patients over 40 years of age who present to the emergency department (ED) with dyspnea. This prospective observational study recruited all consecutive patients with shortness of breath as their chief complaint. Patients were evaluated using REMS and categorized in the ED as low-, intermediate-, or high-risk. In-hospital outcomes and the survival rates of the patients were recorded. The patients’ REMS points and lactate levels were analyzed together to elicit the REMS+L scores used to predict mortality and outcomes. A total of 1044 patients were included in the study. The majority (64.8%, n = 677) of the patients received diagnoses related to the respiratory system, 9.9% (n = 103) with the cardiovascular system, and 25.3% (n = 264) with nonspecific diagnoses. A total of 31% (n = 324) of the patients were hospitalized, while the majority (78%, n = 253) were admitted to an intensive care unit. A total of 104 (10%) died within 28 days, with 23 of those deaths (2.2%) occurring within 2 days. The diagnostic accuracies of lactate, REMS, and REMS+L values were calculated using receiver operating characteristics (ROC) analysis and revealed that the REMS+L score (p < 0.001) was more accurate than the lactate measurements (p < 0.001) and REMS score (p < 0.001) in predicting short-term mortality. The REMS+L score (p < 0.001) was superior to the REMS (p < 0.001) and lactate values (p < 0.001) in predicting mortality. Adding lactate measurements to REMS in patients over 40 years of age who present to the ED with shortness of breath appeared to yield more accurate estimates than using REMS and lactate values alone when determining two-day mortality.


Emergency department; Triage; REMS; Lactate; Shortness of breath; Dyspnea

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Pınar Vargun,Sarper Yilmaz,Ali Cankut Tatliparmak,Ozgur Karcioglu. Should lactate levels be combined with rapid emergency medicine scores (REMS) to predict outcomes of patients with dyspnea. Signa Vitae. 2023. 19(5);161-168.


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