Lactate indices as predictors of in-hospital mortality or 90-day survival after admission to an intensive care unit in unselected critically ill patients

Hayashi, Yusuke; Endoh, Hiroshi; Kamimura, Natuo; Tamakawa, Taro; Nitta, Masakazu

doi:10.1371/journal.pone.0229135

Cited by 27 publications

(30 citation statements)

References 25 publications

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“…Lactate clearance has previously been investigated as a potential prognostic marker for sepsis/septic shock 7 , 9 , 15 , 20 . However, increased lactate clearance is not always associated with decreased mortality in sepsis/septic shock.…”

Section: Discussionmentioning

confidence: 99%

“…We used logistic regression analysis to test the association between lactate clearance and 28-day mortality in patients with TBIL < 2 mg/dL or ≥ 2 mg/dL. Multivariate analysis was performed to adjust for potential baseline imbalances (age, sex, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score), as reported previously 9 , 20 – 22 . Creatinine (Cre) level (< and ≥ 2 mg/dL), platelet count (< and ≥ 80 × 10 3 /mm 3 ), and APACHE II score (< and ≥ 35) were also analyzed to evaluate the association between severity and organ dysfunction.…”

Section: Methodsmentioning

confidence: 99%

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Significance of lactate clearance in septic shock patients with high bilirubin levels

Takahashi

Nakada

Walley

et al. 2021

Sci Rep

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Lactate clearance is affected by hepatic function. However, it is unclear whether the association between hepatic dysfunction and lactate clearance can act as a prognostic marker of clinical outcomes in patients with septic shock. We aimed to evaluate the association between lactate clearance and mortality in two cohorts of septic shock patient who had hepatic dysfunction based on their total serum bilirubin levels (TBIL). Lactate clearance at 24 h after the onset of septic shock was analyzed using two cohorts, sub-categorized into two groups based on TBIL: < 2 mg/dL and ≥ 2 mg/dL. In the derivation cohort, lactate clearance was lower in non-survivors than in survivors with TBIL ≥ 2 mg/dL, while there was no significant difference in lactate clearance between non-survivors and survivors with TBIL < 2 mg/dL. Multivariate logistic regression analysis revealed that increased lactate clearance was significantly associated with decreased 28-day mortality in the TBIL ≥ 2 mg/dL group (10% lactate clearance, adjusted odds ratio [OR]: 0.88, 95% confidence interval (CI): 0.80–0.97, P = 0.0075), Creatinine level ≥ 2 mg/dL group (adjusted OR: 0.88, 95% CI: 0.81–0.95, P = 0.00069) and APACHE II score ≥ 35 group (adjusted OR: 0.93, 95% CI: 0.87–0.98, P = 0.013). In the validation cohort, lactate clearance was lower in non-survivors than in survivors with TBIL ≥ 2 mg/dL, while no significant difference in lactate clearance was observed between non-survivors and survivors with TBIL < 2 mg/dL. Increased lactate clearance was significantly associated with decreased 28-day mortality in the TBIL ≥ 2 mg/dL group (10% lactate clearance, adjusted OR: 0.89, 95% CI: 0.83–0.96, P = 0.0038) and the association was just about significant in APACHE II score ≥ 35 group (adjusted OR: 0.86, 95% CI: 0.74–1.00, P = 0.051). In conclusion, increased lactate clearance in septic shock patients with hepatic dysfunction (TBIL ≥ 2 mg/dL) or high severity (APACHE II score ≥ 35) was associated with decreased 28-day mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Significance of lactate clearance in septic shock patients with high bilirubin levels

Takahashi

Nakada

Walley

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…In the present study of lactate clearance in septic shock patients, strati ed by hepatic dysfunction, increased lactate clearance in the initial 24 hours was signi cantly associated with decreased mortality in patients with TBIL ≥ 2 mg/dL. In contrast, lactate clearance was not associated with altered mortality in patients with TBIL < 2 mg/dL Lactate clearance has been substantially studied as a prognostic marker in sepsis/septic shock [7,9,15,20]. However, increased lactate clearance has not always been observed to be associated with decreased mortality in sepsis/septic shock.…”

Section: Discussionmentioning

confidence: 57%

Significance of lactate clearance in septic shock patients with high bilirubin levels.

Takahashi

Nakada

Walley

et al. 2020

Preprint

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Background Although lactate clearance is affected by hepatic function, it is unclear whether the hepatic dysfunction is associated with lactate clearance as a prognostic marker of clinical outcomes in septic shock. We aimed to evaluate association between the lactate clearance and mortality divided by hepatic dysfunction based on total bilirubin level using two cohort of septic shock patients. Methods Lactate clearance, delta base excess and delta anion gap in 24 hours from septic shock onset were analyzed using two cohorts of septic shock patients (derivation cohort, n = 230; validation cohort, n = 396) categorized into two groups by total bilirubin levels (TBIL) < 2 mg/dL and ≥ 2 mg/dL on day 1. The primary analysis was association between lactate clearance and 28-day mortality by total bilirubin category. Results In derivation cohort, lactate clearance was lower in non-survivors compared to survivors in the patients with TBIL ≥ 2 mg/dL (P = 0.0035), while there was a no significant difference in those with TBIL < 2 mg/dL. There were no significant differences in delta base excess and delta anion gap between non-survivors and survivors both in the patients with TBIL ≥ 2 mg/dL and < 2 mg/dL. In the multivariate logistic regression analysis, increased lactate clearance was significantly associated with decreased 28-day mortality in TBIL ≥ 2 mg/d group (10% lactate clearance, adjusted odds ratio 0.88, 95%CI; 0.80–0.97, P = 0.0075), whereas there was no significant association in TBIL < 2 mg/d group. We next tested for lactate clearance in TBIL ≥ 2 mg/dL using the validation cohort; lactate clearance was lower in non-survivors compared to survivors in the TBIL ≥ 2 mg/dL group (P = 0.0006), while no significant difference was observed in TBIL < 2 mg/dL. Increased lactate clearance was significantly associated with decreased 28-day mortality in the TBIL ≥ 2 mg/dL group (10% lactate clearance, adjusted odds ratio 0.89, 95%CI; 0.83–0.96, P = 0.0038); while no significant difference was observed in TBIL < 2 mg/dL in the validation cohort. Conclusions Patients with increased lactate clearance had decreased 28-day mortality when patients had hepatic dysfunction (TBIL ≥ 2 mg/dL) in septic shock.

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“…In other unselected cohorts of ICU patients, mortality was higher in patients developing high lactate levels after more than 24 hours following ICU admission or missing lactate clearance in the first 12 hours 3 and lactate at 24 hours after admission to ICU was strongest for prediction of mortality 18 . There are systematic reviews available, that found that across different ICU cohorts lactate clearance was associated with a better outcome 19,20 ; the significance of the course of lactate was thereby independent of the initial value and it was recommended to monitor the lactate level by measurements every 1 to 2 hours 21 .…”

Section: Discussionmentioning

confidence: 83%

Course of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients - A Retrospective Cohort Analysis

Schork

Moll

Haap

et al. 2020

Preprint

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Background: We aimed to evaluate the value of lactate, base excess and pH for prediction of mortality in the course of the disease of medical intensive care patients. Methods: For lactate, pH and base excess, values at the admission to intensive care unit (ICU), at 24 ± 4 hours, maximum / minimum in the first 24 hours and in 24 – 48 hours after admission were collected from all patients admitted to the Medical ICU of the University Hospital Tübingen between January 2016 until December 2018 and investigated for prediction of in-hospital-mortality.Results: Mortality in the cohort of 4067 patients was 22 % and significantly correlated with all evaluated parameters. Strongest predictors of mortality determined by ROC were maximum lactate in 24 h (AUROC 0.74, cut off 2.7 mmol/L, hazard ratio of risk group with value > cut off 2.27) and minimum pH in 24 h (AUROC 0.71, cut off 7.43, hazard ratio for risk group 2.94). Kaplan Meier Curves stratified across these cut offs showed early and clear separation. Hazard ratios per standard deviation were highest for maximum lactate in 24 h (HR 1.65), minimum base excess in 24 h (HR 1.56) and minimum pH in 24 h (HR 0.75). In multiple logistic regression analysis, age, minimum pH in 24 h, pH at 24 h after admission, maximum lactate in 24 h, maximum lactate in 24 – 48 h, minimum base excess in 24 h and minimum base excess in 24 – 48 h were independent predictors of mortality. Conclusions: Lactate, pH and base excess were all suitable predictors of mortality in internal ICU patients, with maximum / minimum values in 24 and 24-48 h after admission altogether stronger predictors than values at admission. Base excess and pH were not superior to lactate for prediction of mortality.

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Lactate indices as predictors of in-hospital mortality or 90-day survival after admission to an intensive care unit in unselected critically ill patients

Cited by 27 publications

References 25 publications

Significance of lactate clearance in septic shock patients with high bilirubin levels

Significance of lactate clearance in septic shock patients with high bilirubin levels

Significance of lactate clearance in septic shock patients with high bilirubin levels.

Course of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients - A Retrospective Cohort Analysis

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