Cumulative lactate and hospital mortality in ICU patients

Paul A. van Beest*, Lukas Brander, Sebastiaan P. A. Jansen, Johannes H. Rommes, Michael A. Kuiper, Peter E. Spronk

*Corresponding author for this work

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    Abstract

    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.

    Original languageEnglish
    Article number6
    Number of pages7
    JournalAnnals of Intensive Care
    Volume3
    DOIs
    Publication statusPublished - 27-Feb-2013

    Keywords

    • Lactate
    • Critically ill
    • Intensive care units
    • In-hospital mortality
    • CRITICALLY-ILL PATIENTS
    • SEPTIC SHOCK
    • SEVERE SEPSIS
    • LACTIC-ACIDOSIS
    • ORGAN FAILURE
    • SERUM LACTATE
    • CLEARANCE
    • HYPERLACTATEMIA
    • HEMODYNAMICS
    • PREDICTORS

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