Purpose We compared the use of lactate level for predicting 28-day mortality in non-elderly (<65 years) and elderly (≥65 years) sepsis patients who were admitted to an intensive care unit (ICU). Methods This retrospective study used the Medical Information Mart for Intensive Care III, a publicly available database of ICUs. Eligible sepsis patients were at least 18 years-old, hospitalized for at least 24 h, and had lactate levels measured in the ICU. The relationship of lactate level with 28-day mortality was determined. Results The 28-day mortality was 30.9% among the 2482 patients, and was significantly greater in elderly than non-elderly patients. Within each age group, the lactate level was greater for non-survivors than survivors. Among non-survivors, the lactate level was significantly higher for the non-elderly than the elderly. Adjusted logistic regression analysis showed that elderly and non-elderly patients with lactate levels of 2.0–4.0 mmol/L and above 4.0 mmol/L had greater risk of death than those with normal lactate. Cirrhosis, chronic renal failure, and malignancy were independent risk factors for 28-day mortality in each age group. Based on a lactate cut-off level of 2.1 mmol/L, the area under the receiver operating characteristic curve was 0.628 (overall), 0.707 (non-elderly), and 0.585 (elderly). Conclusion In our population of sepsis patients, a plasma lactate level above 2.0 mmol/L was an independent risk factor for death at 28-days. The lactate level among elderly non-survivors was about 0.9 mmol/L lower than among non-elderly survivors. Lactate was a better prognostic indicator for non-elderly than elderly patients.
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