Lactate measurements accurately predicts 1-week mortality in emergency department patients with acute kidney injury

Bayar, Ayse Elif Aliustaoglu; Aksay, Ersin; Oray, Neşe Çolak

doi:10.1016/j.tjem.2019.08.002

Cited by 6 publications

(3 citation statements)

References 9 publications

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“…The analysis of longitudinal submodel indicated that the use of CRRT tends to increase lactate levels within 28 days, while the joint modeling of longitudinal and survival data indicated that lactate level changes were associated with mortality and that log(lactate) is a risk factor for 28-day mortality in S-AKI patients. Many studies have confirmed lactate as a powerful biomarker for sepsis with renal damage and can accurately predict mortality [ 23 – 25 ]. Reducing lactate is therefore a vital procedure for improving the likelihood of patient survival.…”

Section: Discussionmentioning

confidence: 99%

The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units

Wang

Zhang

et al. 2022

BMC Emerg Med

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Background Sepsis has high incidence and fatality rates in intensive care units, often leading to renal failure. The effectiveness of continuous renal replacement therapy (CRRT) in sepsis-associated acute kidney injury (S-AKI) patients is currently uncertain. Aim Joint model was used to determine the association between CRRT and the lactate trajectory trend and how it correlated to 28-day mortality for S-AKI patient in ICU. Methods A retrospective study was applied to patients with sepsis and AKI, which were extracted from the MIMIC-III public database, with the endpoint being 28-day mortality. Every lactate level measurement within 28 days was observed and calculated using logarithms. Joint model combined the longitudinal analysis of the natural logarithm of the lactate level [log(lactate)] in longitudinal submodel and Cox regression by trajectory function, demonstrating the effects of CRRT on 28-day survival and log(lactate) changes, and its final relationship with the event status. Results Among the 717 S-AKI patients, 157 received CRRT. CRRT was not associated with 28-day mortality. After adjustments, the relationship between CRRT use and log(lactate) elevation was statistically significant. The parameter estimation of CRRT and log(lactate) indicated that using CRRT will increase log(lactate) by 0.041 in S-AKI patients. The joint model also instigated a fixed association between changes in the lactate level and the event result, revealing an exp value of (0.755) = 2.12, indicating that an increase of one unit in log(lactate) will increase the risk of 28-day mortality 2.12-times. Conclusion There was no significant association between CRRT use and 28-day survival in S-AKI patients, and JM showed that CRRT use might be associated with elevation of longitudinal lactate levels. Therefore, additional attention should be paid to other treatments to control lactate levels when providing renal support for patients with S-AKI.

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Section: Discussionmentioning

confidence: 99%

The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units

Wang

Zhang

et al. 2022

BMC Emerg Med

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“…The analysis of longitudinal submodel indicated that the use of CRRT is associated with increases in lactate levels within 28 days, while the joint modeling of longitudinal and survival data indicated that lactate level changes were associated with mortality and that log(lactate) is a risk factor for 28-day mortality in S-AKI patients. Many studies have con rmed lactate as a powerful biomarker for sepsis with renal damage and can accurately predict mortality [23][24][25] . Reducing lactate is therefore a vital procedure for improving the likelihood of patient survival.…”

Section: Discussionmentioning

confidence: 99%

Impact of Continuous Renal Replacement Therapy as Treatment for Sepsis-Associated Acute Kidney Injury on Lactate Levels and the Risk of 28-Day Mortality in Intensive Care Units

Zhang

Wang

et al. 2021

Preprint

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Background: Sepsis has high incidence and fatality rates in intensive care units, often leading to renal failure. The effectiveness of continuous renal replacement therapy (CRRT) in sepsis-associated acute kidney injury (S-AKI) patients is currently uncertain.Aim: Joint mode was used to determine the effect of CRRT on the lactate levels and survival of S-AKI patients.Methods: A retrospective study was applied to patients with sepsis and AKI, which were extracted from the MIMIC-III public database, with the endpoint being 28-day mortality. Every lactate level measurement within 28 days was observed and calculated using logarithms. Joint model combined the longitudinal analysis of the natural logarithm of the lactate level [log(lactate)] in longitudinal submodel and Cox regression by trajectory function, demonstrating the effects of CRRT on 28-day survival and log(lactate) changes, and its final relationship with the event status.Results: Among the 717 S-AKI patients, 157 received CRRT. CRRT was not associated with 28-day mortality. After adjustments, the relationship between CRRT use and log(lactate) elevation was statistically significant. The parameter estimation of CRRT and log(lactate) indicated that using CRRT will increase log(lactate) by 0.041 in S-AKI patients. The joint model also instigated a fixed association between changes in the lactate level and the event result, revealing an exp value of (1.755) =5.78, indicating that an increase of one unit in log(lactate) will increase the risk of 28-day mortality 5.78-fold. Conclusion: CRRT does not improve the prognosis of patients with sepsis and acute kidney injury in critical-care units and has a tendency of increasing lactate levels, which is a significant risk factor for the prognosis.

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“…2 Studies have consistently demonstrated that high lactate level and low lactate clearance are associated with poor prognosis in many clinical cases, such as sepsis, trauma, shock, and cardiac arrest. [3][4][5][6] Particularly in sepsis and septic shock, a lactate value over 4.0mmol/L has been widely researched and linked to increased mortality. 7,8 In subsequent studies on sepsis, a lactate value above 2.0mmol/L has also been identified as a warning sign for poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Lactate and Lactate Clearance with In-Hospital Mortality in Unselected Emergency Department Patients

Susur,

Yesіlaras,

Eyler

2024

Prehosp. Disaster med.

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Introduction: Lactate is a frequently used biomarker in emergency departments (EDs), especially in critically ill patients. The aim of this study is to investigate the relationship between lactate and lactate clearance with in-hospital mortality in unselected ED patients. Methods: This study was carried out retrospectively in the ED of a tertiary hospital. Patients aged 18 years and older whose blood lactate level was obtained in the ED were included in the study. Patients whose lactate value did not have sufficient analytical accuracy, whose lactate value was recorded in the system 180 minutes after admission, who were admitted to the ED as cardiac arrest, and whose ED or hospital outcome was unknown were excluded from the study. According to the first measured lactate value, the patients were divided into three groups: < 2.0mmol/L, 2.0-3.9mmol/L, and ≥ 4.0mmol/L. Lactate clearance was calculated and recorded in patients with one-to-four hours between two lactate values. Results: During the five-year study period, a total of 1,070,406 patients were admitted to the ED, of which 114,438 (10.7%) received blood gas analysis. The median age of 81,449 patients included in the study was 58 years (IQR: 30, min: 18–max: 117) and 54.4% were female. The study found that non-trauma patients with a lactate level between 2.0-3.9mmol/L had a 2.5-times higher mortality risk, while those with a lactate level of ≥ 4.0mmol/L had a 20.8-times higher risk, compared to those with a lactate level < 2.0mmol/L. For trauma patients, the mortality risk was three-times higher for those with lactate levels between 2.0-3.9mmol/L and nine-times higher for those with a lactate level of ≥ 4.0mmol/L, compared to those with a lactate level < 2.0mmol/L. Among patients with a first measured lactate value ≥ 4.0mmol/L and a two-hour lactate clearance < 20%, the mortality rate was 19.7%. In addition, lactate, lactate clearance, and age were independent variables for mortality in this patient group. Conclusion: The lactate value in unselected patients in the ED is a biomarker that can be used to predict the prognosis of the patients. In addition, lactate, lactate clearance, and age are independent predictors of mortality.

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Lactate measurements accurately predicts 1-week mortality in emergency department patients with acute kidney injury

Cited by 6 publications

References 9 publications

The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units

The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units

Impact of Continuous Renal Replacement Therapy as Treatment for Sepsis-Associated Acute Kidney Injury on Lactate Levels and the Risk of 28-Day Mortality in Intensive Care Units

The Relationship Between Lactate and Lactate Clearance with In-Hospital Mortality in Unselected Emergency Department Patients

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