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Karimi E, Gholizadeh M, Abdolahi M, Sedighiyan M, Salehinia F, Siri G, Asanjarani B, Yousefi A, Gandomkar H, Abdollahi H. Effect of vitamin B1 supplementation on blood creatinine and lactate levels and clinical outcomes in patients in intensive care units: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2024; 82:804-814. [PMID: 37553224 DOI: 10.1093/nutrit/nuad096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
CONTEXT The metabolic response to stress can deplete the remaining thiamine stores, leading to thiamine deficiency. OBJECTIVE This study is the first meta-analysis of the effectiveness of thiamine supplementation on clinical and biochemical outcomes in adult patients admitted to the intensive care unit (ICU). DATA SOURCES Scopus, PubMed, and Cochrane databases were searched to select studies up to 20 November 2022. STUDY SELECTION Studies investigating the effect of thiamine supplementation on serum lactate and creatinine levels, the need for renal replacement therapy, length of ICU stay, and mortality rate in ICU patients were selected. DATA EXTRACTION After excluding studies based on title and abstract screening, 2 independent investigators reviewed the full texts of the remaining articles. In the next step, a third investigator resolved any discrepancy in the article selection process. RESULTS Of 1628 retrieved articles, 8 were selected for final analysis. This study showed that thiamine supplementation reduced the serum creatinine level (P = .03) compared with placebo. In addition, according to subgroup analysis, serum creatinine concentration was significantly lower in patients >60 years old (P < .00001). However, there was no statistically significant difference in the lactate level between the thiamine supplementation and placebo groups (P = .26). Thiamine supplementation did not decrease the risk of all-cause mortality (P = .71) or the need for renal replacement therapy (P = .14). The pooled results of eligible randomized controlled trials also showed that thiamine supplementation did not reduce the length of ICU stay in comparison to the placebo group (P = .39). CONCLUSION This meta-analysis provides evidence that thiamine supplementation has a protective effect against blood creatinine increase in ICU patients. However, further high-quality trials are needed to discover the effect of thiamine supplementation on clinical and biochemical outcomes in ICU patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO no. CRD42023399710 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399710).
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Affiliation(s)
- Elmira Karimi
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Mohammad Gholizadeh
- Faculty of Nutrition and Food Technology, Department of Clinical Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Abdolahi
- Department of Clinical Nutrition, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sedighiyan
- Faculty of Nutrition and Food Technology, Department of Clinical Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Salehinia
- Department of Internal Medicine, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Goli Siri
- Department of Internal Medicine, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Asanjarani
- Department of Internal Medicine, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolghasem Yousefi
- Department of Anesthesiology, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Gandomkar
- Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Abdollahi
- Department of Anesthesiology, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
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Oladipo V, Portney D, Haber J, Baker H, Strelzow J. Lactic acid levels are associated with morbidity, length of stay, and total treatment costs in urban trauma patients with lower extremity long bone fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1963-1970. [PMID: 38480531 DOI: 10.1007/s00590-024-03877-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/18/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Lactic acid is well studied in the trauma population and is frequently used as a laboratory indicator that correlates with resuscitation status and has thus been associated with patient outcomes. There is limited literature that assesses the association of initial lactic acid with post-operative morbidity and hospitalization costs in the orthopedic literature. The purpose of this study was to assess the association of lactic acid levels and alcohol levels post-operative morbidity, length of stay and admission costs in a cohort of operative lower extremity long bone fractures, and to compare these effects in the ballistic and blunt trauma sub-population. METHODS Patients presenting as trauma activations who underwent tibial and/or femoral fixation at a single institution from May 2018 to August 2020 were divided based on initial lactate level into normal, (< 2.5) intermediate (2.5-4.0), and high (> 4.0). Mechanism of trauma (blunt vs. ballistic) was also stratified for analysis. Data on other injuries, surgical timing, level of care, direct hospitalization costs, length of stay, and discharge disposition were collected from the electronic medical record. The primary outcome assessed was post-operative morbidity defined as in-hospital mortality or unanticipated escalation of care. Secondary outcomes included hospital costs, lengths of stay, and discharge disposition. Data were analyzed using ANOVA and multivariate regression. RESULTS A total of 401 patients met inclusions criteria. Average age was 34.1 ± 13.0 years old, with patients remaining hospitalized for 8.8 ± 9.5 days, and 35.2% requiring ICU care during their hospitalization. Patients in the ballistic cohort were younger, had fewer other injuries and had higher lactate levels (4.0 ± 2.4) than in the blunt trauma cohort (3.4 ± 1.9) (p = 0.004). On multivariate regression, higher lactate was associated with post-operative morbidity (p = 0.015), as was age (p < 0.001) and BMI (p = 0.033). ISS, ballistic versus blunt injury mechanism, and other included laboratory markers were not. Lactate was also associated with longer lengths of stay, and higher associated direct hospitalization cost (p < 0.001) and lower rates of home disposition (p = 0.008). CONCLUSION High initial lactate levels are independently associated with post-operative morbidity as well as higher direct hospitalization costs and longer lengths of stay in orthopedic trauma patients who underwent fixation for fractures of the lower extremity long bones. Ballistic trauma patients had significantly higher lactate levels compared to the blunt cohort, and lactate was not independently associated with increased rates of post-operative morbidity in the ballistic cohort alone. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Victoria Oladipo
- Department of Orthopaedic Surgery, University of Chicago, Chicago, USA
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, USA
| | - Daniel Portney
- Department of Orthopaedic Surgery, University of Chicago, Chicago, USA.
| | - Jordan Haber
- Department of Orthopaedic Surgery, University of Chicago, Chicago, USA
- Ohio State University School of Medicine, Columbus, USA
| | - Hayden Baker
- Department of Orthopaedic Surgery, University of Chicago, Chicago, USA
| | - Jason Strelzow
- Department of Orthopaedic Surgery, University of Chicago, Chicago, USA
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Sheng B, Li S, Wang H, Guo Z, Zhang Z. Association between serum lactate, lactate clearance rate, and 30-day mortality among patients undergoing mechanical ventilation: A retrospective cohort study of MIMIC-III database. Medicine (Baltimore) 2024; 103:e35818. [PMID: 38277542 PMCID: PMC10817166 DOI: 10.1097/md.0000000000035818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/05/2023] [Indexed: 01/28/2024] Open
Abstract
Serum lactate has been used as a prognostic indicator in intensive care unit patients, and however, the single lactate value may not be enough to reflect changes during illness conditions. Herein, this study aims to explore the association between serum lactate and lactate clearance rate and 30-day mortality in patients undergoing mechanical ventilation (MV). Demographic and clinical data of 2628 adults were extracted from the medical information mart for intensive care-III clinical database in this retrospective cohort study. The lactate clearance rate was calculated using the serum lactate at the beginning of MV (T0), and serum lactate at the12 hours after MV beginning (T1). Univariate and multivariate Cox regression analyses were used to screen covariates, and explore the association between serum lactate and lactate clearance rate and 30-day mortality. We also explored these associations in different T0 serum lactate level subgroups. The evaluation indexes were hazard ratios (HRs) and 95% CIs. In addition, receiver operator characteristic (ROC) curve with area under the curve (AUC) was used to reflect the predictive performance of serum lactate and lactate clearance rate on 30-day mortality. A total of 827 (31.47%) mechanically ventilated patients died within 30 days. After adjusting for covariates, elevated T0 (HR = 1.04, 95%CI: [1.02-1.07]) and T1 (HR = 1.07, 95%CI: [1.04-1.10]) serum lactate was both associated with an increased risk of 30-day mortality, while higher lactate clearance rate was negatively associated with the risk of 30-day mortality (HR = 0.64, 95%CI: [0.50-0.81]). Among patients with T0 lactate ≥2 mmol/L, T1 serum lactate ≥4 mmol/L was associated with an increased risk of 30-day mortality, while lactate clearance rate ≥50 was associated with a decreased risk (all P < .05). Moreover, T1 serum lactate had a potential predictive value on 30-day mortality with an AUC of 0.605. Serum lactate and lactate clearance rate were both associated with 30-day mortality in patients undergoing MV. Our results may provide some references for further studies to explore the roles of serum lactate and lactate clearance rate in prognoses of critical patients.
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Affiliation(s)
- Bo Sheng
- Department of Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
| | - Shan Li
- Department of Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
| | - He Wang
- Department of Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
| | - Zhe Guo
- Department of Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
| | - Zhenyu Zhang
- Department of Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
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Vorbeck J, Bachmann M, Düsing H, Hartensuer R. Mortality Risk Factors of Severely Injured Polytrauma Patients (Prehospital Mortality Prediction Score). J Clin Med 2023; 12:4724. [PMID: 37510839 PMCID: PMC10380896 DOI: 10.3390/jcm12144724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of this study was to analyze the mortality of polytrauma patients and identify prediction parameters. A further aim was to create from the results a score for the prehospital predictive evaluation of 30-day survival. The study was conducted with a retrospective, observational design and was carried out unicentrically at a Level 1 Trauma Center. During the 4-year investigation period, patients with an Injury Severity Score (ISS) ≥ 16 were examined and their demographic basic data, laboratory values, and vital parameters were recorded. The mortality data analysis was performed using Kaplan-Meier Analysis and Log-Rank tests. Cox regressions were carried out to determine influencing factors and Receiver Operating Characteristic (ROC) curves were plotted to establish limit values for potential influencing factors. All statistical tests were conducted at a significance level of p ≤ 0.05. Coronary Heart Disease (CHD), cardiopulmonary resuscitation (CPR), age at admission, sex, and Glasgow Coma Scale (GCS) had a significant impact on the survival of polytrauma patients. The identified prediction parameters were combined with the shock index (SI). The generated score showed a sensitivity of 93.1% and a specificity of 73.3% in predicting the mortality risk. The study was able to identify significant influencing prehospital risk factors on 30-day survival after polytrauma. A score created from these parameters showed higher specificity and sensitivity than other prediction scores. Further studies with a larger number of participants and the inclusion of slightly injured patients could verify these findings.
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Affiliation(s)
- Jana Vorbeck
- Surgical Clinic II, Aschaffenburg-Alzenau Hospital, 63739 Aschaffenburg, Germany
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, 48149 Münster, Germany
| | - Manuel Bachmann
- Surgical Clinic II, Aschaffenburg-Alzenau Hospital, 63739 Aschaffenburg, Germany
| | - Helena Düsing
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, 48149 Münster, Germany
| | - René Hartensuer
- Surgical Clinic II, Aschaffenburg-Alzenau Hospital, 63739 Aschaffenburg, Germany
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Alshiakh SM. Role of serum lactate as prognostic marker of mortality among emergency department patients with multiple conditions: A systematic review. SAGE Open Med 2023; 11:20503121221136401. [PMID: 36643203 PMCID: PMC9834787 DOI: 10.1177/20503121221136401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/16/2022] [Indexed: 01/12/2023] Open
Abstract
Objective In the Emergency Department, the physician's purpose is to rapidly and accurately diagnose the severity of a patient's condition so that proper treatment can be administered. Therefore, this study pays close attention to the association and prognostic value of blood lactate on different disease outcomes by systematically reviewing recently published studies. Methods The search strategy was developed based on searches in the year 2022 for potential publications including original articles, case reports, and reviews using the following web databases google scholar, PubMed, and Science Direct. A total of 25 studies were identified and reviewed extensively to evaluate the link between mortality and serum lactate levels. Results This literature review presents the strong association of elevated serum lactate levels with the in-hospital mortality rate among emergency department patients. Conclusion These findings suggest that even a moderately raised lactate level in serum can predict the severe outcome in emergency department patients suffering from different conditions. Therefore, early (at the time of administration of hospital) and periodic serum lactate value determination through different techniques and scores is of need and should become part of routine analyses in emergency department to predict and choose therapies that could benefit critically ill patients.
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Affiliation(s)
- Safinaz M Alshiakh
- Safinaz M Alshiakh, Department of Emergency
Medicine, Faculty of Medicine, King AbdulAziz University, P.O.Box: 80200,
Jeddah, 21589, Saudi Arabia.
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Jyoti D, Kumar A, Halim T, Hai AA. The Association Between Serum Lactate Concentration, Base Deficit, and Mortality in Polytrauma Patients as a Prognostic Factor: An Observational Study. Cureus 2022; 14:e28200. [PMID: 36158397 PMCID: PMC9484334 DOI: 10.7759/cureus.28200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction In polytrauma patients, it is crucial to identify the severity of the injuries to ensure patient safety and survival. Polytrauma leads to hypotension and hypoperfusion, which results in an anaerobic metabolism with acidosis and a decrease in base excess. Thus, blood lactate levels above a certain threshold indicate the existence of global tissue hypoxia, which is a precursor to shock and multiple organ dysfunction syndrome (MODS). The serum lactate and base deficit (BD) levels are used in polytrauma patients as measures of damage severity and resuscitation endpoints and as a way to evaluate therapy efficacy and to predict outcomes. Thus, arterial blood gas analysis is of great value in assessing the status and prognosis of patients with polytrauma. There are few comparative studies on the predictive values of these markers in trauma patients. To determine which measure can more accurately predict the prognosis of polytrauma patients, the present study investigated the predictive values of mortality of these indicators for mortality within 48 hours of admission to the emergency room (ER) in patients with polytrauma. Methods This prospective study was designed for a single tertiary care center in northern India. We included 90 patients with polytrauma who were between the ages of 18 and 70 years, with the exception of pregnant women, who presented to the ER within six hours of injury with an injury severity score (ISS) >16, serum lactate level >2.0 mmol/L, and BD -4.0 mEq/L at the time of admission. If the patient's ISS was >16 at the time of ER presentation, arterial blood samples were drawn to determine the serum lactate and BD level at the time of admission and at 12, 24, and 48 hours intervals after ER admission. The primary outcome was the change in serum lactate and BD level in polytrauma. The secondary outcomes were an association of serum lactate and BD with mortality and the correlation between serum lactate with the BD and ISS with mortality of polytrauma patients. The timing of all outcome assessments was at 48 hours after each patient's ER admission. Results Lactate clearance from 0-12 hours (t = 2.28, p <0.05), 0-24 hours (t = 6.01, p <0.001), and 0-48 hours (t = 7.98, p <0.001) and a correction in BD from 0-24 (t = 2.68, p <0.01 ) and 0-48 hours (t = 5.46, p <0.001) were significantly higher in nonsurvivors as compared with survivors. In survivors and nonsurvivors, mean serum lactate levels (2.46 ± 1.46 versus 4.15 ± 2.99, t = 3.31, p <0.001, 95%Cl) and mean BD (-3.17 ± 2.58 versus -6.5 ± 4.91, t = 3.86, p <0.001, 95%CI) had a statistically significant difference. The serum lactate and BD levels at time of ER admission (r L0, BD0 = -0.765, p <0.01) and 48 hours after ER admission (r L48, BD 48 = -0.652, p <0.001) were highly negatively correlated. Conclusion In polytrauma patients, serum lactate and BD are simple, quick, and independent biochemical predictors of 48-hour mortality, and this single arterial blood test would thereby improve decision-making for resuscitation effectiveness. Prolonged lactate and BD normalization time were associated with higher mortality. Serum lactate and BD are negatively correlated. A higher ISS at admission was associated with a higher incidence of mortality in polytrauma patients.
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Wang R, He M, Qu F, Zhang J, Xu J. Lactate Albumin Ratio Is Associated With Mortality in Patients With Moderate to Severe Traumatic Brain Injury. Front Neurol 2022; 13:662385. [PMID: 35432157 PMCID: PMC9011050 DOI: 10.3389/fneur.2022.662385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a serious public health issue all over the world. This study was designed to evaluate the prognostic value of lactate to albumin ratio (LAR) on patients with moderate to severe TBI. Methods Clinical data of 273 moderate to severe TBI patients hospitalized in West China Hospital between May 2015 and January 2018 were collected. Multivariate logistic regression analyses were used to explore risk factors and construct a prognostic model of in-hospital mortality in this cohort. A receiver operating characteristic (ROC) curve was drawn to evaluate the discriminative ability of this model. Results Non-survivors had higher LAR than survivors (1.09 vs. 0.53, p < 0.001). Results of multivariate logistic regression analysis showed that Glasgow Coma Scale (GCS; odds ratio [OR] = 0.743, p = 0.001), blood glucose (OR = 1.132, p = 0.005), LAR (OR = 1.698, p = 0.022), subdural hematoma (SDH; OR = 2.889, p = 0.006), intraparenchymal hemorrhage (IPH; OR = 2.395, p = 0.014), and diffuse axonal injury (DAI; OR = 2.183, p = 0.041) were independent risk factors of in-hospital mortality in included patients. These six factors were utilized to construct the prognostic model. The area under the ROC curve (AUC) values of single lactate, albumin, and LAR were 0.733 (95% Cl; 0.673–0.794), 0.740 (95% Cl; 0.683–0.797), and 0.780 (95% Cl; 0.725–0.835), respectively. The AUC value of the prognostic model was 0.857 (95%Cl; 0.812–0.901), which was higher than that of LAR (Z = 2.1250, p < 0.05). Conclusions Lactate to albumin ratio is a readily available prognostic marker of moderate to severe TBI patients. A prognostic model incorporating LAR is beneficial for clinicians to evaluate possible progression and make treatment decisions in TBI patients.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Min He
| | - Fengyi Qu
- Department of Radiation Oncolygy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Jianguo Xu
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Pattharanitima P, Thongprayoon C, Petnak T, Srivali N, Gembillo G, Kaewput W, Chesdachai S, Vallabhajosyula S, O’Corragain OA, Mao MA, Garovic VD, Qureshi F, Dillon JJ, Cheungpasitporn W. Machine Learning Consensus Clustering Approach for Patients with Lactic Acidosis in Intensive Care Units. J Pers Med 2021; 11:jpm11111132. [PMID: 34834484 PMCID: PMC8623582 DOI: 10.3390/jpm11111132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lactic acidosis is a heterogeneous condition with multiple underlying causes and associated outcomes. The use of multi-dimensional patient data to subtype lactic acidosis can personalize patient care. Machine learning consensus clustering may identify lactic acidosis subgroups with unique clinical profiles and outcomes. METHODS We used the Medical Information Mart for Intensive Care III database to abstract electronic medical record data from patients admitted to intensive care units (ICU) in a tertiary care hospital in the United States. We included patients who developed lactic acidosis (defined as serum lactate ≥ 4 mmol/L) within 48 h of ICU admission. We performed consensus clustering analysis based on patient characteristics, comorbidities, vital signs, organ supports, and laboratory data to identify clinically distinct lactic acidosis subgroups. We calculated standardized mean differences to show key subgroup features. We compared outcomes among subgroups. RESULTS We identified 1919 patients with lactic acidosis. The algorithm revealed three best unique lactic acidosis subgroups based on patient variables. Cluster 1 (n = 554) was characterized by old age, elective admission to cardiac surgery ICU, vasopressor use, mechanical ventilation use, and higher pH and serum bicarbonate. Cluster 2 (n = 815) was characterized by young age, admission to trauma/surgical ICU with higher blood pressure, lower comorbidity burden, lower severity index, and less vasopressor use. Cluster 3 (n = 550) was characterized by admission to medical ICU, history of liver disease and coagulopathy, acute kidney injury, lower blood pressure, higher comorbidity burden, higher severity index, higher serum lactate, and lower pH and serum bicarbonate. Cluster 3 had the worst outcomes, while cluster 1 had the most favorable outcomes in terms of persistent lactic acidosis and mortality. CONCLUSIONS Consensus clustering analysis synthesized the pattern of clinical and laboratory data to reveal clinically distinct lactic acidosis subgroups with different outcomes.
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Affiliation(s)
- Pattharawin Pattharanitima
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12121, Thailand
- Correspondence: (P.P.); (C.T.); (W.C.)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
- Correspondence: (P.P.); (C.T.); (W.C.)
| | - Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Narat Srivali
- Division of Pulmonary Medicine, St. Agnes Hosipital, Baltimore, MD 21229, USA;
| | - Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand;
| | - Supavit Chesdachai
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA;
| | - Oisin A. O’Corragain
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - John J. Dillon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
- Correspondence: (P.P.); (C.T.); (W.C.)
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Kim K, Ha G, Jang SW, Jang JY, Bae KS. Determination of the radiologic findings for predicting failure of conservative management with observation for blunt renal injury patients: A single-centre experience over 13 years. Injury 2021; 52:2588-2593. [PMID: 34134853 DOI: 10.1016/j.injury.2021.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/10/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Most blunt renal injuries (BRIs) are managed conservatively without complications. Because conservative management with observation (CMO) is widely conducted, failed CMO is frequent. Clarifying the role and indication of CMO is important to manage BRI patients. Therefore, this study was conducted to analyse factors related to failed CMO. METHODS BRI patients (aged >13 years) who were admitted via the emergency department in Wonju Severance Christian Hospital were analysed retrospectively between January 2008 and July 2020. Patient characteristics, including clinical data, laboratory findings, transfusion requirements, injury grade, initial CT findings, length of hospital stay, intensive care unit stay, and mortality, were investigated for all enrolled patients. RESULTS Kidney injury grade ≥ 4, perinephric haematoma rim distance (PHD), length of main laceration, intravascular contrast extravasation (ICE), Gerota's fascia discontinuity, multiple lacerations, dissociated renal fragment and complexity of laceration were statistically significantly different between the successful CMO and failed CMO groups in the comparative analysis. The multivariate analysis showed that perinephric haematoma rim distance [odds ratio (OR) 1.44 [95% confidence interval (CI) 1.09 - 1.90], p = 0.011] and ICE [OR 7.41 (95% CI 2.20 - 24.99), p = 0.001] were mutually independent risk factors associated with failed CMO. When the ROC curve of PHD and ICE was generated to predict the failure of CMO, the area under the curve (AUC) was 0.884 (95% CI, 0.826 - 0.942), p < 0.001), and the optimal cut-off value for PHD was 2.9 cm, and for ICE was presence of ICE on CT [sensitivity: 90.5% (95% CI, 0.70 - 0.99), specificity: 78.0% (95% CI, 0.73 - 0.83)]. CONCLUSION PHD and ICE may be useful factors to predict failed CMO for BRI patients. PHD > 2.9 cm and the presence of ICE may indicate who will require invasive procedures. Close observation is wise for patients with these risk factors.
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Affiliation(s)
- Kwangmin Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Gaesung Ha
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sung Woo Jang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Ji Young Jang
- Department of Surgery, Trauma Center, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Keum Seok Bae
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea; Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.
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Ha G, Jang SW, Shin IS, Bang HJ, An S, Bae KS, Jang JY, Kim YW, Kim K. Finding new indicators for operation and angiographic embolization in blunt renal injury patients: a single-center experience over 13 years. Ann Surg Treat Res 2021; 101:49-57. [PMID: 34235116 PMCID: PMC8255582 DOI: 10.4174/astr.2021.101.1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Traumatic kidney injury can be treated surgically or nonsurgically. Nonsurgical treatment options include angiography, embolization, and conservative treatment. We aimed to identify factors that help in making clinical decisions on treatment plans for patients with traumatic kidney injury caused by blunt trauma. Methods The study included 377 patients aged ≥18 years with traumatic kidney injury caused by blunt abdominal trauma admitted to the emergency room of Wonju Severance Christian Hospital between January 2008 and July 2020. Medical records, laboratory test results, and computed tomography results were retrospectively reviewed. Results Multivariable logistic analysis showed diastolic blood pressure at admission and disruption of Gerota's fascia were significantly associated with surgical treatment, and that perinephric hematoma rim distance was the only significant indicator favoring embolization. Receiver operating characteristic curve analysis showed that angiography and embolization should be considered when hematoma size exceeds 2.97 cm. Conclusion When a patient with traumatic kidney injury due to blunt trauma visits an emergency room, even when vital signs are stable, Gerota's fascia should be checked by computed tomography prior to deciding on surgical treatment, and angiographic embolization should be considered if perinephric hematoma rim distance exceeds 2.97 cm.
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Affiliation(s)
- Gaesung Ha
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sung Woo Jang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - In Sik Shin
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Hui-Jae Bang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sanghyun An
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Keum Seok Bae
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
| | - Ji Young Jang
- Department of Surgery, Trauma Center, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Young Wan Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
| | - Kwangmin Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.,Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea.,Wonju Severance Surgical Research Group, Wonju Severance Christian Hospital, Wonju, Korea
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11
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Chen Y, Du Y, Sun C, Tan W. Lactate is Associated with Increased 30-Day Mortality in Critically Ill Patients with Alcohol Use Disorder. Int J Gen Med 2021; 14:2741-2749. [PMID: 34194237 PMCID: PMC8236836 DOI: 10.2147/ijgm.s314821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/28/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To investigate the predictive value of lactate for prognosis in critically ill patients with AUD. Methods A retrospective cohort study was performed using data extracted from a freely accessible critical care database (MIMIC-III). We studied all patients with AUD from the database for whom lactate was available. The clinical outcomes were 30-day mortality. Analyses included LOWESS curve fitting, logistic multivariate regression model, receiver operating characteristic (ROC) analysis and subgroup analysis. Results A total of 1296 eligible critically ill patients with AUD were included and there were 223 non-survivors (17.2%). The non-survivors had a higher lactate than the survivors (p < 0.001). A nonlinear relationship between lactate and 30-day mortality was observed. Multivariate logistic regression indicated lactate could be an independent risk factors to predict the prognosis of critically ill patients with AUD. According to ROC curve analysis, the area under the curve predicted by lactate for 30-day mortality was 0.672 (95% CI, 0.634 to 0.711). Subgroup analysis did not find obvious interaction in most subgroups. Conclusion High lactate was associated with increased mortality in critically ill patients with AUD.
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Affiliation(s)
- Yu Chen
- Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Yuanyuan Du
- Nursing School, Peking University, Beijing, People's Republic of China
| | - Cheng Sun
- Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Wenliang Tan
- Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
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12
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DSouza D, Sunny A, Sima R, Ashwath G, Rozario AP. Lactate Measurement in Critically Injured—Prognostic Importance. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02551-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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13
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Li Y, Chen L, Xing C, Ding C, Zhang H, Wang S, Long Y, Guo J, Liao Q, Zhang T, Zhao Y, Dai M. Changes in Serum Lactate Level Predict Postoperative Intra-Abdominal Infection After Pancreatic Resection. World J Surg 2021; 45:1877-1886. [PMID: 33604712 DOI: 10.1007/s00268-021-05987-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Postoperative intra-abdominal infection is one of the most serious complications after pancreatic resection. In this article, we investigated the relationship between serum lactate level and postoperative infection, to suggest a new predictor of potential infection risk after pancreatectomy. METHODS A retrospective analysis of 156 patients who underwent pancreatic surgery and admitted in the intensive care unit for recovery after surgery between August 2017 and August 2019 was performed. RESULTS The basic characteristics, preoperative information, pathological diagnoses, surgical methods, and intraoperative situations of patients in the postoperative intra-abdominal infection group (n = 52) and non-infection group (n = 104) showed no significant differences. With the same postoperative treatments and results of fluid balance, blood pressure maintenance, and laboratory tests, postoperative serum lactate level increased much higher in the infection group than non-infection group (P < 0.001), while the base excess level declined much lower (P = 0.002). Patients in the infection group needed more time to elute lactate (P < 0.001), and stayed longer in the intensive care unit after surgery (P = 0.007). The overall postoperative complications were certainly more in the infection group (P < 0.001), resulting in a longer hospitalization time (P < 0.001). CONCLUSIONS When patients recovered smoothly from anesthesia with a stable hemodynamics situation and normal results of laboratory tests, abnormally high serum lactate level could be a predictor of postoperative intra-abdominal infection after pancreatic resection.
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Affiliation(s)
- Yatong Li
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Lixin Chen
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Cheng Xing
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Cheng Ding
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Hanyu Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Shunda Wang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yun Long
- Department of Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | - Junchao Guo
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Quan Liao
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Taiping Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Menghua Dai
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, China.
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14
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van Breugel JMM, Niemeyer MJS, Houwert RM, Groenwold RHH, Leenen LPH, van Wessem KJP. Global changes in mortality rates in polytrauma patients admitted to the ICU-a systematic review. World J Emerg Surg 2020; 15:55. [PMID: 32998744 PMCID: PMC7526208 DOI: 10.1186/s13017-020-00330-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/19/2020] [Indexed: 11/17/2022] Open
Abstract
Background Many factors of trauma care have changed in the last decades. This review investigated the effect of these changes on global all-cause and cause-specific mortality in polytrauma patients admitted to the intensive care unit (ICU). Moreover, changes in trauma mechanism over time and differences between continents were analyzed. Main body A systematic review of literature on all-cause mortality in polytrauma patients admitted to ICU was conducted. All-cause and cause-specific mortality rates were extracted as well as trauma mechanism of each patient. Poisson regression analysis was used to model time trends in all-cause and cause-specific mortality. Thirty studies, which reported mortality rates for 82,272 patients, were included and showed a decrease of 1.8% (95% CI 1.6–2.0%) in all-cause mortality per year since 1966. The relative contribution of brain injury-related death has increased over the years, whereas the relative contribution of death due to multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome, and sepsis decreased. MODS was the most common cause of death in North America, and brain-related death was the most common in Asia, South America, and Europe. Penetrating trauma was most often reported in North America and Asia. Conclusions All-cause mortality in polytrauma patients admitted to the ICU has decreased over the last decades. A shift from MODS to brain-related death was observed. Geographical differences in cause-specific mortality were present, which may provide region-specific learning possibilities resulting in improvement of global trauma care.
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Affiliation(s)
- Johanna M M van Breugel
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3585 GA, Utrecht, The Netherlands.
| | - Menco J S Niemeyer
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3585 GA, Utrecht, The Netherlands
| | - Roderick M Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3585 GA, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3585 GA, Utrecht, The Netherlands
| | - Karlijn J P van Wessem
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3585 GA, Utrecht, The Netherlands
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15
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Mishra M, Zeeshan Hakim M, Prakash Mishra S, Saxena S, Trivedi N. Evaluation of Lactate and Lactate Clearance as a Marker of Outcome in Trauma ICU. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2020. [DOI: 10.18311/ajprhc/2020/25642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Prognostic Value of Serum Lactate Levels in Critically Ill Patients in an Intensive Care Unit. ACTA ACUST UNITED AC 2020; 6:59-64. [PMID: 32104732 PMCID: PMC7029407 DOI: 10.2478/jccm-2020-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/29/2020] [Indexed: 12/03/2022]
Abstract
Introduction The 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. Objective To determine the prognostic value of serum lactate in an Intensive Care Unit (ICU). Method One 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. Results Twenty-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). Conclusions Patient assessment through the determination of serum lactate levels provides useful information in the initial evaluation of the critical patient.
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17
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The Association of Perioperative Serum Lactate Levels with Postoperative Delirium in Elderly Trauma Patients. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3963780. [PMID: 31828102 PMCID: PMC6881750 DOI: 10.1155/2019/3963780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/25/2019] [Accepted: 10/23/2019] [Indexed: 02/04/2023]
Abstract
Background Several studies have shown the utility of lactate level as a predictor of early outcomes in trauma patients. We conducted this study to evaluate the association of perioperative serum lactate levels with postoperative delirium (POD) in elderly trauma patients. Materials and Methods This study included 466 elderly trauma patients with measurements of serum lactate levels on admission and 1 h after surgery. The associations of POD with serum lactate levels (on admission and 1 h after surgery) and lactate clearance were analyzed using Kendall's correlation. Perioperative serum lactate levels and lactate clearance as predictors of POD were evaluated using univariate and multivariable analyses. Results The incidence of POD in the present study was 38.1%. Serum lactate levels on admission and at 1 h after surgery were significantly higher in major trauma than in minor trauma. In univariate analysis of perioperative serum lactate levels and lactate clearance as predictors of POD, the odds ratio (OR) for serum lactate level on admission was 4.19 (P < 0.01, 2.91 < 95% confidence interval (CI) < 6.02) and that 1 h after surgery was 3.83 (P < 0.01, 2.79 < 95% CI < 5.25); however, the OR for serum change of lactate level was 0.99 ((P < 0.09, 0.99 < 95% CI < 1.00). In multivariable analysis for predictors of POD, the OR for serum lactate level on admission was 2.40 (P < 0.09, 0.87 < 95% CI < 6.7), that for serum lactate 1 h after surgery was 2.83 (P=0.01, 1.28 < 95% CI < 6.24), that for ICU admission was 3.01 (P=0.01, 2.09 < 95% CI < 6.03), and that for ISS was 1.47 (P < 0.01, 1.27 < 95% CI < 3.70). Conclusions Taking together the results of univariate and multivariable analyses, serum lactate level 1 h after surgery may be used as a prediction model of POD development in elderly trauma patients.
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18
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Bozorgi F, Hedayatizadeh-Omran A, Alizadeh-Navaei R, Goli Khatir I, Amjadi O, Khademloo M, Banihashemi AA. Diagnostic value of serum lactate as a predictor and early outcome in multiple trauma patients. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04916-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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19
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Yucel N, Ozturk Demir T, Derya S, Oguzturk H, Bicakcioglu M, Yetkin F. Potential Risk Factors for In-Hospital Mortality in Patients with Moderate-to-Severe Blunt Multiple Trauma Who Survive Initial Resuscitation. Emerg Med Int 2018; 2018:6461072. [PMID: 30595921 PMCID: PMC6282151 DOI: 10.1155/2018/6461072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/11/2018] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION The aim was to identify risk factors that influence in-hospital mortality for patients with moderate-to-severe blunt multiple trauma (BMT) who survive initial resuscitation. METHODS The prospective study involved 195 adult patients with BMT who were admitted to a referral hospital's emergency department (ED) between May 1, 2015, and May 31, 2016. RESULTS Forty-three (22%) of the 195 patients died in hospital. Multivariate analysis identified low blood pH (odds ratio [OR] 6.580, 95% confidence interval [CI] 1.12-38.51), high serum lactate level (OR 1.041, 95% CI 1.01-1.07), high ISS (OR 1.109, 95% CI 1.06-1.16), high APACHE II score (OR 1.189, 95% CI 1.07-1.33), traumatic brain injury (TBI) (OR 4.358, 95% CI 0.76-24.86), severe hemorrhage (OR 5.314, 95% CI 1.07-26.49), and coagulopathy (OR 5.916, 95% CI 1.17-29.90) as useful predictors of acute in-hospital mortality. High ISS (OR 1.047, 95% CI 1.02-1.08), TBI (OR 8.922, 95% CI 2.57-31.00), sepsis (OR 4.956, 95% CI 1.99-12.36), acute respiratory distress syndrome (ARDS) (OR 8.036, 95% CI 1.85-34.84), respiratory failure (OR 9.630, 95% CI 2.64-35.14), renal failure (OR 74.803, 95% CI 11.34-493.43), and multiple organ failure [MOF] (OR 10.415, 95% CI 4.48-24.24) were risk factors for late in-hospital mortality. High Glasgow Coma Scale (GCS) was a good predictor for survival at 2, 7, and 28 or more days of hospitalization (OR 0.708 and 95% CI 0.56-0.09; OR 0.835 and 95% CI 0.73-0.95; OR 0.798 and 95% CI 0.71-0.90, resp.). CONCLUSION Several factors signal poor short-term outcome for patients who present to the ED with moderate-to-severe BMT: low blood pH, high serum lactate level, presence of TBI, severe hemorrhage, coagulopathy, organ failure (respiratory, renal, and MOF), and ARDS. For this patient group, ISS and APACHE II scores might be helpful for stratifying by mortality risk, and GCS might be a good predictor for survival.
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Affiliation(s)
- Neslihan Yucel
- Department of Emergency Medicine, Inonu University, School of Medicine, Malatya, Turkey
| | - Tuba Ozturk Demir
- Department of Emergency Medicine, Inonu University, School of Medicine, Malatya, Turkey
| | - Serdar Derya
- Department of Emergency Medicine, Inonu University, School of Medicine, Malatya, Turkey
| | - Hakan Oguzturk
- Department of Emergency Medicine, Inonu University, School of Medicine, Malatya, Turkey
| | - Murat Bicakcioglu
- Department of Anesthesiology and Reanimation, Inonu University, School of Medicine, Malatya, Turkey
| | - Funda Yetkin
- Department of Infectious Disease and Clinical Microbiology, Inonu University, School of Medicine, Malatya, Turkey
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20
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Kim H, Choi S, Park E, Yoon E, Min Y, Lampotang S. Serum markers and development of delayed neuropsychological sequelae after acute carbon monoxide poisoning: anion gap, lactate, osmolarity, S100B protein, and interleukin-6. Clin Exp Emerg Med 2018; 5:185-191. [PMID: 30269454 PMCID: PMC6166038 DOI: 10.15441/ceem.17.217] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/29/2017] [Indexed: 12/15/2022] Open
Abstract
Objective Reliable biomarkers of delayed neuropsychological sequelae (DNS) after acute carbon monoxide (CO) poisoning are lacking. This study investigated the associations between potential serum markers and the development of DNS after acute CO poisoning. Methods Retrospective chart reviews were conducted for patients diagnosed with acute CO poisoning during a 28-month period. The patients were divided into two groups according to the presence or absence of having developed DNS. Multivariate analysis was performed to identify predictors of DNS after CO poisoning. Results Of a total of 102 patients, 10 (9.8%) developed DNS. The levels of serum osmolarity, S100B protein, and serum lactate, as well as serum anion gap, were statistically significant in univariate analysis. Multiple logistic regression analysis showed that anion gap (adjusted odds ratio [AOR], 1.36; 95% confidence interval [CI], 1.11 to 1.88), serum lactate level (AOR, 1.74; 95% CI, 1.26 to 2.75), and serum S100B protein level ([AOR, 7.02×105; 95% CI, 4.56×102 to 9.00×1010] in model 1, [AOR, 3.69×105; 95% CI, 2.49×102 to 2.71×1011] in model 2) were independently associated with DNS development. Conclusion Based on our preliminary results, serum lactate level, serum anion gap, and serum S100B protein level in the emergency department could be informative predictors of DNS development in patients with acute CO poisoning. These markers might have the potential to improve early recognition of DNS in patients with acute CO poisoning.
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Affiliation(s)
- Hyukhoon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sangchun Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.,Center for Safety, Simulation & Advanced Learning Technologies, University of Florida, Gainesville, FL, USA
| | - Eunjung Park
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Eunhui Yoon
- Center for Safety, Simulation & Advanced Learning Technologies, University of Florida, Gainesville, FL, USA
| | - Younggi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Samsun Lampotang
- Center for Safety, Simulation & Advanced Learning Technologies, University of Florida, Gainesville, FL, USA
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Godinjak A, Jusufovic S, Rama A, Iglica A, Zvizdic F, Kukuljac A, Tancica I, Rozajac S. Hyperlactatemia and the Importance of Repeated Lactate Measurements in Critically Ill Patients. Med Arch 2018; 71:404-407. [PMID: 29416200 PMCID: PMC5770196 DOI: 10.5455/medarh.2017.71.404-407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective The aim of the study was to describe the prevalence of hyperlactatemia and emphasis on repeated lactate measurements in critically ill patients, and the associated mortality. Materials and methods The study included 70 patients admitted in the Medical Intensive Care Unit at the Clinical Center, University of Sarajevo, in a 6-month period (July - December 2015). The following data were obtained: age, gender, reason for admission, Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation, lactate concentrations upon admission, after 24 and 48 hours, and outcome (discharge from hospital or death). Results Upon admission,hyperlactatemia was present in 91.4% patients with a mean concentration of lactate 4.13 ±1.21 mmol/L. Lactate concentration at 48 hours was independently associated within creased in-hospital mortality (P = 0.018). Conclusion Persistent hyperlactatemia is associated with adverse outcome in critically ill patients. Lactate concentration at 48 hours is independently associated within creased in-hospital mortality and it represents a statistically significant predictive marker of fatal outcomes of patients. Blood lactate concentrations > 2.25 mmol/L should be used by clinicians to identify patients at higher risk of death.
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Affiliation(s)
- Amina Godinjak
- Clinic for Emergency Medicine, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Selma Jusufovic
- Clinic for Nuclear Medicine and Endocrinology, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Admir Rama
- Bahceci IVF Center Sarajevo, Bosnia and Herzegovina
| | - Amer Iglica
- Clinic for Heart, Vascular diseases and Rheumatology, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Faris Zvizdic
- Clinic for Heart, Vascular diseases and Rheumatology, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Adis Kukuljac
- Medical High School Jezero, Sarajevo, Bosnia and Herzegovina
| | - Ira Tancica
- Clinic for Gastroenterohepatology, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Sejla Rozajac
- Primary Health care Center Fojnica, Fojnica, Bosnia and Herzegovina
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22
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Umebachi R, Taira T, Wakai S, Aoki H, Otsuka H, Nakagawa Y, Inokuchi S. Measurement of blood lactate, D-dimer, and activated prothrombin time improves prediction of in-hospital mortality in adults blunt trauma. Am J Emerg Med 2017; 36:370-375. [PMID: 28869098 DOI: 10.1016/j.ajem.2017.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/11/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Rimako Umebachi
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan.
| | - Takayuki Taira
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
| | - Shinjiro Wakai
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
| | - Hiromichi Aoki
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
| | - Hiroyuki Otsuka
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
| | - Yoshihide Nakagawa
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
| | - Sadaki Inokuchi
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Japan
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23
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Bou Chebl R, El Khuri C, Shami A, Rajha E, Faris N, Bachir R, Abou Dagher G. Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study. Scand J Trauma Resusc Emerg Med 2017; 25:69. [PMID: 28705203 PMCID: PMC5512839 DOI: 10.1186/s13049-017-0415-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022] Open
Abstract
Background Elevated lactate has been found to be associated with a higher mortality in a diverse patient population. The aim of the study is to investigate if initial serum lactate level is independently associated with hospital mortality for critically ill patients presenting to the Emergency Department. Methods Single-center, retrospective study at a tertiary care hospital looking at patients who presented to the Emergency Department (ED) between 2014 and 2016. A total of 450 patients were included in the study. Patients were stratified to lactate levels: <2 mmol/L, 2-4 mmol/L and >4 mmol/L. The primary outcome was in-hospital mortality. Secondary outcomes included 72-h hospital mortality, ED and hospital lengths of stay. Results The mean age was 64.87 ± 18.08 years in the <2 mmol/L group, 68.51 ± 18.01 years in the 2-4 mmol/L group, and 67.46 ± 17.67 years in the >4 mmol/L group. All 3 groups were comparable in terms of age, gender and comorbidities except for diabetes, with the 2-4 mmol/L and >4 mmol/L groups having a higher proportion of diabetic patients. The mean lactate level was 1.42 ± 0.38 (<2 mmol/L), 2.72 ± 0.55 (2-4 mmol/L) and 7.18 ± 3.42 (>4 mmol/L). In-hospital mortality was found to be 4 (2.7%), 18(12%) and 61(40.7%) patients in the low, intermediate and high lactate groups respectively. ED and hospital length of stay were longer for the >4 mmol/L group as compared to the other groups. While adjusting for all variables, patients with intermediate and high lactate had 7.13 (CI 95% 2.22–22.87 p = 0.001) and 29.48 (CI 95% 9.75–89.07 p = <0.001) greater odds of in-hospital mortality respectively. Discussion Our results showed that for all patients presenting to the ED, a rising lactate value is associated with a higher mortality. This pattern was similar regardless of patients’ age, presence of infection or blood pressure at presentation. Conclusion Higher lactate values are associated with higher hospital mortalities and longer ED and hospital lengths of stays. Initial ED lactate is a useful test to risk-stratify critically ill patients presenting to the ED.
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Affiliation(s)
- Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christopher El Khuri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shami
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eva Rajha
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nagham Faris
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Bachir
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Lactate serial measurements and predictive validity of early mortality in trauma patients admitted to the intensive care unit. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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25
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Mediciones seriadas del lactato y su validez predictiva de la mortalidad temprana en los pacientes con politrauma que ingresan a la unidad de cuidado intensivo. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lactate serial measurements and predictive validity of early mortality in trauma patients admitted to the intensive care unit☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201707000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kamal A, Kanakeshwar RB, Shyam A, Jayaramaraju D, Agraharam D, Perumal R, Rajasekaran S. Variation in practice preferences in management of open injuries of extremities-an international survey by SICOT research academy. INTERNATIONAL ORTHOPAEDICS 2016; 41:3-11. [PMID: 27778039 DOI: 10.1007/s00264-016-3311-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/03/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE Open fractures are challenging injuries and there is a lot of variation in practice preferences which may reflect the wide variations in outcome in different units across the world. A survey was done amongst the international community of SICOT membership to document the practice preferences and variations. METHODS An online questionnaire containing 23 questions which were sub-divided into three sections covering the various aspects of open injury management was sent by email to orthopaedic trauma surgeons across the world. A total of 358 responses were evaluated and presented in this manuscript. RESULTS The SICOT study confirmed wide variation in practice protocols. About 94.7 % of orthopaedic surgeons around the world use the Gustillo Anderson scoring system for assessment of open injury and 50.6 % of surgeons prefer lavage in operation theatre. For lavage, 84.6 % of surgeons preferred normal saline and for antibiotic prophylaxis, 48.3 % used a combination of second generation cephalosporin, metronidazole and an aminoglycoside for a minimum of three to five days. In 88 % of patients, orthopaedic surgeons performed the initial debridement and 69.2 % surgeons aimed for debridement within six hours. Regarding wound management, 43.9 % units preferred and were capable of soft tissue cover within 72 hours and about 26.3 % surgeons combined definitive fixation along with plastic procedure. CONCLUSION Our study documented wide variations in practice preferences across the world and showed that information and awareness about current guidelines and practices will help many to update themselves in terms of basic questions about open fracture care.
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Affiliation(s)
- Arun Kamal
- Department of spine surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, India
| | | | - Ashok Shyam
- Department of spine surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, India
| | | | - Devendra Agraharam
- Department of spine surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, India
| | - Ramesh Perumal
- Department of spine surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, India
| | - Shanmuganathan Rajasekaran
- Department of spine surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, India.
- Department of Orthopaedics & Spine surgery, Ganga Hospital, Mettuplayam road, Coimbatore, India.
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Vincent JL, Quintairos E Silva A, Couto L, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:257. [PMID: 27520452 PMCID: PMC4983759 DOI: 10.1186/s13054-016-1403-5] [Citation(s) in RCA: 281] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/01/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The time course of blood lactate levels could be helpful to assess a patient's response to therapy. Although the focus of published studies has been largely on septic patients, many other studies have reported serial blood lactate levels in different groups of acutely ill patients. METHODS We performed a systematic search of PubMed, Science Direct, and Embase until the end of February 2016 plus reference lists of relevant publications. We selected all observational and interventional studies that evaluated the capacity of serial blood lactate concentrations to predict outcome. There was no restriction based on language. We excluded studies in pediatric populations, experimental studies, and studies that did not report changes in lactate values or all-cause mortality rates. We separated studies according to the type of patients included. We collected data on the number of patients, timing of lactate measurements, minimum lactate level needed for inclusion if present, and suggested time interval for predictive use. RESULTS A total of 96 studies met our criteria: 14 in general ICU populations, five in general surgical ICU populations, five in patients post cardiac surgery, 14 in trauma patients, 39 in patients with sepsis, four in patients with cardiogenic shock, eight in patients after cardiac arrest, three in patients with respiratory failure, and four in other conditions. A decrease in lactate levels over time was consistently associated with lower mortality rates in all subgroups of patients. Most studies reported changes over 6, 12 or 24 hrs, fewer used shorter time intervals. Lactate kinetics did not appear very different in patients with sepsis and other types of patients. A few studies suggested that therapy could be guided by these measurements. CONCLUSIONS The observation of a better outcome associated with decreasing blood lactate concentrations was consistent throughout the clinical studies, and was not limited to septic patients. In all groups, the changes are relatively slow, so that lactate measurements every 1-2 hrs are probably sufficient in most acute conditions. The value of lactate kinetics appears to be valid regardless of the initial value.
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| | - Amanda Quintairos E Silva
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Lúcio Couto
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
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