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 A retrospective cohort study in Intensive care unit (ICU) of the Sixth People’s Hospital in Shanghai, China. A total of 1465 ICU patients who had lactate values > 2.1 mmol/L at least once within 24 hrs of ICU admission and arterial blood gas monitored more than twice during the ICU stay. Results The predictive value of lactate clearance24hrs 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 clearance24hrs 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 clearance24hrs combined with the APACHE II score was also significantly higher than that of lactate clearance24hrs or the APACHE II score alone. In particular, the area under the ROC 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.