Repeat lactate level predicts mortality better than rate of clearance

Dezman, Zachary D.W.; Comer, Angela C.; Smith, Gordon S.; Hu, Peter; Mackenzie, Colin F.; Scalea, Thomas M.; Hirshon, Jon Mark

doi:10.1016/j.ajem.2018.03.012

Cited by 16 publications

(22 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The recorded mortality was 7.3%. The average initial lactate levels of the survivors were lower than the deceased, with a statistically significant difference [10]. In a recent study at the San Vicente Foundation University Hospital (Medellin, Colombia), 251 polytrauma patients were evaluated, who were given lactate measures at admission, at 6 and 24 hours, 15.5% died, serum lactate upon admission was 4.6 mmol / L (IQR = 2.9-6.9) and an important association with mortality was found in the adjusted logistic regression model [11].…”

Section: Discussionmentioning

confidence: 78%

“…A previous study on traumatized patients showed that an initial lactate level of more than 4 mmol / L is associated with an increase in the probability of death in the acute phase [9]. Zachary et al retrospectively evaluated lactate levels in patients with closed or open trauma, at least twice in the first twenty-four hours of admission [10]. The recorded mortality was 7.3%.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Value of Serum Lactate Levels in Critically Ill Patients in an Intensive Care Unit

Gutiérrez

Concepción

Pérez

et al. 2020

The Journal of Critical Care Medicine

View full text Add to dashboard Cite

IntroductionThe patient in critical condition, regardless of the cause of admission, continues to be a challenge for health systems due to the high mortality that it reports. There is a need to identify some marker of early obtaining, easy to interpret and with high relevance in the prognosis of these patients.ObjectiveTo determine the prognostic value of serum lactate in an Intensive Care Unit (ICU).MethodOne hundred and forty-five patients admitted to an ICU were enrolled in the study. The Acute Physiology and Chronic Health Evaluation II (APACHE) prognosis score, Sequential Organ Failure Assessment, hemodynamic support need, mechanical ventilation, cause of admission, stay in ICU, analytical and physiological variables were determined. The probability of survival of patients who had elevated and normal serum lactate levels was calculated. The risk of dying was determined using the Cox regression model.ResultsTwenty-eight patients died (19%) in the ICU. The serum lactate value was higher in the group of patients with trauma, infections, APACHE II and high creatinine levels; as well as with decreased mean arterial blood pressure, need for hemodynamic support and mechanical ventilation. The survival capacity was higher in patients who had normal serum lactate. Serum lactate was the sole independent predictor of mortality (AHR 1.28 [1.07-1.53], p = 0.008).ConclusionsPatient assessment through the determination of serum lactate levels provides useful information in the initial evaluation of the critical patient.

show abstract

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Serum Lactate Levels in Critically Ill Patients in an Intensive Care Unit

Gutiérrez

Concepción

Pérez

et al. 2020

The Journal of Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Given the different conditions, our study also showed that 6-hour lactate levels had a better prognostic value than the initial lactate levels and lactate clearance. A previous study [23] reported that the optimal cutoff values to predict survival are <3.7 mmol/L for the second lactate measurement and ≥32% for lactate clearance. The results of this study were similar to those of our study (≥3.5 mmol/L for 6-hour lactate and <24.4% for lactate clearance to predict 30-day mortality).…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: a retrospective cohort study according to the Sepsis-3 definitions

Lee

Song

Cho

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: This study evaluated the prognostic value of lactate levels and lactate clearance for the prediction of mortality in sepsis and septic shock patients.Methods: We performed a retrospective cohort study of sepsis and septic shock patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (<10%, <20%, and <30%) was evaluated. We compared the sensitivity and specificity between metrics.Results: Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower lactate clearance than those of survivors. Six-hour lactate levels and lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097–1.294] and 0.989 [0.983–0.995], respectively). Six-hour lactate levels had better prognostic value than lactate clearance (area under the curve, 0.720 [95% CI, 0.670–0.765] vs. 0.656 [0.605–0.705]; p = 0.018). A 6-hour lactate level of ≥3.5 mmol/L and a lactate clearance of <24.4% were the optimal cutoff values in predicting the 30-day mortality. The prognostic value of 6-hour lactate metrics and lactate clearance metrics did not differ. Six-hour lactate levels (≥2 mmol/L) had the highest sensitivity (89.2%).Conclusions: Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than lactate clearance.

show abstract

“…Early assessment of the clinical status of severely injured patients is of pivotal importance in guiding surgical and intensive care management [1][2][3][4]. Blood transfusions have been associated with acute and long-term complications [5][6][7][8][9]. Most authors agree that the prediction of early mortality is equally important as predicting complications in the later stages.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, this value was to be relevant in predicting early complications (24-hour mortality) [6]. Dezman et al [7] stated that the underlying population of trauma patients includes a fair number of penetrating injuries known to result in acute, sustained blood loss. In a similar population, the same group identified "failure of lactate clearance" as an important predictor of 24-hour mortality [7].…”

Section: Introductionmentioning

confidence: 99%

How to detect a polytrauma patient at risk of complications: A validation and database analysis of four published scales

et al. 2020

View full text Add to dashboard Cite

Introduction Early accurate assessment of the clinical status of severely injured patients is crucial for guiding the surgical treatment strategy. Several scales are available to differentiate between risk categories. They vary between expert recommendations and scores developed on the basis of patient data (level II). We compared four established scoring systems in regard to their predictive abilities for early (e.g., hemorrhage-induced mortality) versus late (Multiple Organ Failure (MOF), sepsis, late death) in-hospital complications. Methods A database from a level I trauma center was used. The inclusion criteria implied an injury severity score (ISS) of �16 points, primary admission, and a complete data set from admission to hospital-day 21. The following four scales were tested: the clinical grading scale (CGS; covers acidosis, shock, coagulation, and soft tissue injuries), the modified clinical grading scale (mCGS; covers CGS with modifications), the polytrauma grading score (PTGS; covers shock, coagulation, and ISS), and the early appropriate care protocol (EAC; covers acid-base changes). Admission values were selected from each scale and the following endpoints were compared: mortality, pneumonia, sepsis, death from hemorrhagic shock, and multiple organ failure. Statistics Shapiro-Wilk test for normal distribution, Pearson Chi square, odds ratios (OR) for all endpoints, 95% confidence intervals. Fitted, generalized linear models were used for prediction analysis. Krippendorff was used for comparison of CGS and mCGS. Alpha set at 0.05. Results In total, 3668 severely injured patients were included (mean age, 45.8±20 years; mean ISS, 28.2±15.1 points; incidence of pneumonia, 19.0%; incidence of sepsis, 14.9%; death from

show abstract

Repeat lactate level predicts mortality better than rate of clearance

Abstract: The absolute value of the repeat lactate measurement had the greatest ability to predict mortality in injured patients undergoing resuscitation.

Cited by 16 publications

References 43 publications

Prognostic Value of Serum Lactate Levels in Critically Ill Patients in an Intensive Care Unit

Prognostic Value of Serum Lactate Levels in Critically Ill Patients in an Intensive Care Unit

Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: a retrospective cohort study according to the Sepsis-3 definitions

How to detect a polytrauma patient at risk of complications: A validation and database analysis of four published scales

Contact Info

Product

Resources

About