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Cumulative lactate and hospital mortality in ICU patients

BACKGROUND: Both hyperlactatemia and persistence of hyperlactatemia have been associated with bad outcome. We compared lactate and lactate-derived variables in outcome prediction. METHODS: Retrospective observational study. Case records from 2,251 consecutive intensive care unit (ICU) patients admit...

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Autores principales: van Beest, Paul A, Brander, Lukas, Jansen, Sebastiaan PA, Rommes, Johannes H, Kuiper, Michaël A, Spronk, Peter E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599274/
https://www.ncbi.nlm.nih.gov/pubmed/23446002
http://dx.doi.org/10.1186/2110-5820-3-6
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author van Beest, Paul A
Brander, Lukas
Jansen, Sebastiaan PA
Rommes, Johannes H
Kuiper, Michaël A
Spronk, Peter E
author_facet van Beest, Paul A
Brander, Lukas
Jansen, Sebastiaan PA
Rommes, Johannes H
Kuiper, Michaël A
Spronk, Peter E
author_sort van Beest, Paul A
collection PubMed
description BACKGROUND: Both hyperlactatemia and persistence of hyperlactatemia have been associated with bad outcome. We compared lactate and lactate-derived variables in outcome prediction. METHODS: Retrospective observational study. Case records from 2,251 consecutive intensive care unit (ICU) patients admitted between 2001 and 2007 were analyzed. Baseline characteristics, all lactate measurements, and in-hospital mortality were recorded. The time integral of arterial blood lactate levels above the upper normal threshold of 2.2 mmol/L (lactate-time-integral), maximum lactate (max-lactate), and time-to-first-normalization were calculated. Survivors and nonsurvivors were compared and receiver operating characteristic (ROC) analysis were applied. RESULTS: A total of 20,755 lactate measurements were analyzed. Data are srpehown as median [interquartile range]. In nonsurvivors (n = 405) lactate-time-integral (192 [0–1881] min·mmol/L) and time-to-first normalization (44.0 [0–427] min) were higher than in hospital survivors (n = 1846; 0 [0–134] min·mmol/L and 0 [0–75] min, respectively; all p < 0.001). Normalization of lactate <6 hours after ICU admission revealed better survival compared with normalization of lactate >6 hours (mortality 16.6% vs. 24.4%; p < 0.001). AUC of ROC curves to predict in-hospital mortality was the largest for max-lactate, whereas it was not different among all other lactate derived variables (all p > 0.05). The area under the ROC curves for admission lactate and lactate-time-integral was not different (p = 0.36). CONCLUSIONS: Hyperlactatemia is associated with in-hospital mortality in a heterogeneous ICU population. In our patients, lactate peak values predicted in-hospital mortality equally well as lactate-time-integral of arterial blood lactate levels above the upper normal threshold.
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spelling pubmed-35992742013-03-19 Cumulative lactate and hospital mortality in ICU patients van Beest, Paul A Brander, Lukas Jansen, Sebastiaan PA Rommes, Johannes H Kuiper, Michaël A Spronk, Peter E Ann Intensive Care Research BACKGROUND: Both hyperlactatemia and persistence of hyperlactatemia have been associated with bad outcome. We compared lactate and lactate-derived variables in outcome prediction. METHODS: Retrospective observational study. Case records from 2,251 consecutive intensive care unit (ICU) patients admitted between 2001 and 2007 were analyzed. Baseline characteristics, all lactate measurements, and in-hospital mortality were recorded. The time integral of arterial blood lactate levels above the upper normal threshold of 2.2 mmol/L (lactate-time-integral), maximum lactate (max-lactate), and time-to-first-normalization were calculated. Survivors and nonsurvivors were compared and receiver operating characteristic (ROC) analysis were applied. RESULTS: A total of 20,755 lactate measurements were analyzed. Data are srpehown as median [interquartile range]. In nonsurvivors (n = 405) lactate-time-integral (192 [0–1881] min·mmol/L) and time-to-first normalization (44.0 [0–427] min) were higher than in hospital survivors (n = 1846; 0 [0–134] min·mmol/L and 0 [0–75] min, respectively; all p < 0.001). Normalization of lactate <6 hours after ICU admission revealed better survival compared with normalization of lactate >6 hours (mortality 16.6% vs. 24.4%; p < 0.001). AUC of ROC curves to predict in-hospital mortality was the largest for max-lactate, whereas it was not different among all other lactate derived variables (all p > 0.05). The area under the ROC curves for admission lactate and lactate-time-integral was not different (p = 0.36). CONCLUSIONS: Hyperlactatemia is associated with in-hospital mortality in a heterogeneous ICU population. In our patients, lactate peak values predicted in-hospital mortality equally well as lactate-time-integral of arterial blood lactate levels above the upper normal threshold. Springer 2013-02-27 /pmc/articles/PMC3599274/ /pubmed/23446002 http://dx.doi.org/10.1186/2110-5820-3-6 Text en Copyright ©2013 van Beest et al; licensee Springer. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
van Beest, Paul A
Brander, Lukas
Jansen, Sebastiaan PA
Rommes, Johannes H
Kuiper, Michaël A
Spronk, Peter E
Cumulative lactate and hospital mortality in ICU patients
title Cumulative lactate and hospital mortality in ICU patients
title_full Cumulative lactate and hospital mortality in ICU patients
title_fullStr Cumulative lactate and hospital mortality in ICU patients
title_full_unstemmed Cumulative lactate and hospital mortality in ICU patients
title_short Cumulative lactate and hospital mortality in ICU patients
title_sort cumulative lactate and hospital mortality in icu patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599274/
https://www.ncbi.nlm.nih.gov/pubmed/23446002
http://dx.doi.org/10.1186/2110-5820-3-6
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