The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically Ill patients: a retrospective cohort study

Abstract

Background The mortality rate is high in critically ill patients due to the difficulty of diagnosis and treatment. Thus, it is very important to explore the predictive value of different indicators related to prognosis in critically ill patients. Methods This was a retrospective cohort study of patients in the intensive care unit (ICU) of the Sixth People’s Hospital in Shanghai, China. A total of 1465 ICU patients had lactate values > 2.1 mmol/L at least once within 24 h of ICU admission, and arterial blood gas was monitored more than twice during the ICU stay. Results The predictive value of lactate clearance at 24 h was not high, and the sensitivity and specificity were lower. The predictive value of the lactate level at baseline and the APACHE II score was higher than that of lactate clearance at 24 h in critically ill patients. The predictive value of the lactate level at baseline combined with the APACHE II score was higher than that of the lactate level at baseline or the APACHE II score alone. In addition, the predictive value of lactate clearance at 24 h combined with the APACHE II score was also significantly higher than that of lactate clearance at 24 h or the APACHE II score alone. In particular, the area under the ROC curve reached 0.900, the predictive value was markedly higher than that of the ROC alone, and the sensitivity and specificity were better when these three indicators were combined. Conclusions The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically ill patients.

The relationship of CURB65-L and CURB65-LC (lactate clearance) with mortality in pneumonia patients admitted to the emergency department

“…Furthermore, a correlation was established between decreasing LC and increasing mortality. [5]. Our study revealed that high-risk patients who died, received MV or VS, and were admitted to the ICU had lower levels of LC compared to mild-moderate risk patients.…”

“…The primary factors contributing to excessive lactate production include hypoxia, alterations in mitochondrial oxidation, and glycolysis [13]. There are many studies in the literature about the prognostic power of lactate in critically ill geriatric patients, hemorrhagic shock, and trauma, where there is tissue hypoperfusion [5,14,15,16]. ED often employs serum lactate levels to assess several acute medical conditions [17].…”

“…ED often employs serum lactate levels to assess several acute medical conditions [17]. Hyperlactatemia, a laboratory finding that can be easily measured, is known to be linked with poor outcomes in critically ill patients, including the requirement for MV, admission to the ICU, and in-hospital mortality [5,6]. The current guidelines for sepsis recommend using serum lactate as a supplementary test to establish the possibility of sepsis in these patients [18].…”

“…Thus, the measurement of lactate levels upon admission to the ED can effectively assist clinicians in forecasting unfavorable outcomes. Since the sensitivity and specificity of a single lactate value is controversial, it has been stated that serial measurements over time or LC may be more reliable indicators [5,7]. A study found that focusing on LC rather than a single lactate level would have a more significant impact on reducing mortality [19].…”

“…While a high lactate value at admission is linked to prognosis, a single lactate measurement may exhibit static variability [4]. Hence, it is advisable to assess the levels of lactate and its fluctuations during the 2nd, 6th, and 24th hours throughout research investigations [5]. Yadigaroğlu M et al demonstrated that the measurement of lactate levels and lactate clearance (LC) within 24 hours can serve as a reliable predictor of mortality in patients with COVID-19 pneumonia [6].…”