Prognostic relevance of serum lactate kinetics in critically ill patients

Masyuk, Maryna; Wernly, Bernhard; Lichtenauer, Michael; Franz, Marcus; Kabisch, Bjoern; Muessig, Johanna M.; Zimmermann, Georg; Lauten, Alexander; Schulze, P. Christian; Hoppe, Uta C.; Kelm, Malte; Bakker, Jan; Jung, Christian

doi:10.1007/s00134-018-5475-3

Cited by 114 publications

(90 citation statements)

References 39 publications

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“…Recently, Masyuk et al [24] showed a dynamic index, Δ 24Lac (the difference between maximum lactate on day 1 and day 2) was associated with in-hospital and long-term mortality in unselected ICU patients. The predictor of max lactate at T24 in this study is the final concentration of lactate over the first 24h, which may be relevant to the Δ 24 Lac.…”

Section: Static Lactate Indexmentioning

confidence: 99%

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

et al. 2020

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BackgroundWe performed an exclusive study to investigate the associations between a total of 23 lactate-related indices during the first 24h in an intensive care unit (ICU) and in-hospital mortality. MethodsNine static and 14 dynamic lactate indices, including changes in lactate concentrations (Δ Lac) and slope (linear regression coefficient), were calculated from individual critically ill patient data extracted from the Multiparameter Intelligent Monitoring for Intensive Care (MIMIC) III database. ResultsData from a total of 781 ICU patients were extracted, consisted of 523 survivors and 258 non-survivors. The in-hospital mortality rate for this cohort was 33.0%. A multivariate logistic regression model identified maximal lactate concentration at 24h after ICU admission (max lactate at T24) as a significant predictor of in-hospital mortality (odds ratio = 1.431, 95% confidence interval [CI] = 1.278-1.604, p<0.001) after adjusting for predefined confounders (age, gender, sepsis, Elixhauser comorbidity score, mechanical ventilation, renal replacement therapy, vasopressors, ICU severity scores). Area under curve (AUC) for max lactate at T24 was larger (AUC = 0.776, 95% CI = 0.740-0.812) than other indices (p<0.001), comparable to an APACHE III score of 0.771. When combining max lactate at T24 with APACHE III, the AUC was increased to 0.815 (95% CI:0.783-0.847). The sensitivity, specificity, and positive and negative predictive values for the cut-off value of 3.05 mmol/L were 64.3%, 77.4%, 58.5%, and 81.5%, respectively.Kaplan-Myer survival curves of the max lactate at T24 for 90-day survival after admission to ICU demonstrated a significant difference according to the cut-off value (p<0.001). ConclusionsThese data indicate that the maximal arterial lactate concentration at T24 is a robust predictor of in-hospital mortality as well as 90-day survival in unselected ICU patients with predictive ability as comparable with APACHE III score.

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Section: Static Lactate Indexmentioning

confidence: 99%

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

et al. 2020

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“…2 One of the important way to decrease the mortality is early identification of sepsis and start early management. [3][4][5] Base deficit is one of the important parameter in sepsis and septic shock investigation and management in current days. 6 If we can predict the mortality of patients with sepsis in emergency room and aggressively resuscitate them, the mortality rate can be decreased.…”

Section: Introductionmentioning

confidence: 99%

Base Deficit as a Predictor of Mortality in Sepsis and Septic Shock

Bhusal

Prasad

Shakya

et al. 2019

J. Karnali Acad. Health Sci.

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Introduction: Sepsis is a common problem encountered in emergency room which needs to be intervened early. It is always difficult to have quick prognostic marker of sepsis in busy emergency. So this study was conducted to determine whether base deficit can be used as an indicator of mortality among septic patients in emergency room setup like ours. Methods: It was a hospital based descriptive cross sectional study done at Tribhuvan University Teaching Hospital, Kathmandu from March 2018 to December 2018. Acute physiology and chronic health Evaluation II score (APACHE II), Base deficit, Sequential Organ Failure Assessment (SOFA) score on first day of arrival in emergency room was calculated. The association of 28-day outcome with acute physiology and chronic Health Evaluation II score, Base deficit value and SOFA score were derived. Results: Out of 229 patients with septic shock 62 died (27%) and among 71 patients without septic shock, 12 died (16.9%).Overall mortality was 24.66 % (n= 74).The area under the ROC curve for Base deficit(0.864;95% C.I.=0.822-0.906), APACHE II (0.782; 95% C.I=0.718-0.848, SOFA (0.689;95% C.I=0.620-0.757) were greater than 0.7 except for SOFA which signifies these test to have fair efficacy to predict mortality. Conclusions: High base deficit value predicts mortality in patients with sepsis and septic shock. The base deficit could be used as an alternate marker to predict mortality in septic patient. We recommend for large multicenter study with randomization so that the findings can be applied to general population and of different geographical situations.

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“…In the current case, the authors decided on a surgical cut‐down including a vascular prosthetic graft sutured to the right axillary artery by end‐to‐side anastomosis. After insertion of an Impella 5.0, hemodynamic values improved, which is known to be associated with improved survival . The patient underwent subsequent double patch repair of the ventricular septal defect including coronary artery bypass grafting on cardiopulmonary bypass with Impella removal during the procedure.…”

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confidence: 99%