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Qian X, Sheng Y, Jiang Y, Xu Y. Associations of serum lactate and lactate clearance with delirium in the early stage of ICU: a retrospective cohort study of the MIMIC-IV database. Front Neurol 2024; 15:1371827. [PMID: 39011361 PMCID: PMC11246852 DOI: 10.3389/fneur.2024.1371827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/12/2024] [Indexed: 07/17/2024] Open
Abstract
Aim This study aimed to investigate the associations of serum lactate level [within and after 24 h of the intensive care unit (ICU) admission] and lactate clearance rate with delirium and assess associations of lactate and lactate clearance rate with 30-day mortality in delirium patients. Methods Data in this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database in 2012-2019. The associations of lactate and lactate clearance rate with delirium were explored through univariable and multivariable logistic regression analyses, whereas the associations of lactate and lactate clearance rate with 30-day mortality in delirium patients were investigated using univariable and multivariable Cox regression analyses. Subgroup analysis was performed for age, gender, sepsis, hypertension, sedative drug, ventilation, antibiotic drug, vasopressors, and the Sequential Organ Failure Assessment (SOFA) score. The evaluation indexes were odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs). Results Among 7,812 (14.58%) eligible participants, 4,338 (8.19%) had delirium and 1,903 (24.36%) died within 30 days. After adjusting for covariates, patients with lactic acidosis (lactate level > 5 mmol/L and PH < 7.35) at T0 (within 24 h of the ICU admission) had higher odds of delirium (OR = 1.235, 95%CI: 1.105-1.382). Hyperlactatemia (lactate level 2-5 mmol/L and PH > 7.35) at T1 (after 24 h of the ICU admission) was also associated with higher odds of delirium (OR = 1.277, 95%CI: 1.126-1.447). Lactate clearance rate > 50% was linked to lower odds of delirium (OR = 0.705, 95%CI: 0.613-0.811), and this relationship was also observed in ≥65 years old, female, male, non-sepsis, sepsis, non-hypertension, non-sedative drug use, sedative drug use, ventilation, antibiotic drug use, use of vasopressors, and different SOFA score subgroups (all p < 0.05). Additionally, hyperlactatemia and lactic acidosis (whether at T0 or T1) may be potential risk factors for 30-day mortality in delirium patients, whereas lactate clearance rate ≥ 0 had a potential protective effect on 30-day mortality (all p < 0.05). Conclusion Higher serum lactate levels in the early stage of the ICU were associated with a higher risk of delirium and subsequent mortality. Measures taken to increase the lactate clearance rate are necessary to reduce potential delirium or mortality risk in clinical settings. However, more evidence from prospective studies is needed to verify these findings.
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Affiliation(s)
- Xiangfeng Qian
- Department of Emergency Medicine, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi Sheng
- Department of Emergency Medicine, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yinsheng Jiang
- Department of Emergency Medicine, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yong'an Xu
- Department of Emergency Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Trebuian CI, Marza AM, Chioibaş R, Şutoi D, Petrica A, Crintea-Najette I, Popa D, Borcan F, Flondor D, Mederle OA. Lactate Profile Assessment-A Good Predictor of Prognosis in Patients with COVID-19 and Septic Shock Requiring Continuous Renal Therapy. Clin Pract 2024; 14:980-994. [PMID: 38921256 PMCID: PMC11202829 DOI: 10.3390/clinpract14030078] [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: 04/17/2024] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Lactate is a useful prognostic marker, as its level increases in hypoxic tissue and/or during accelerated aerobic glycolysis due to excessive beta-adrenergic stimulation and decreased lactate clearance. The Surviving Sepsis Campaign Bundle 2018 Update suggests premeasurement of lactate within 2-4 h so that physicians perform, assist, administer, and introduce lactate-guided resuscitation to reduce mortality due to sepsis. METHODS A total of 108 patients with septic shock who underwent continuous renal replacement therapy (CRRT) for acute kidney injury were enrolled in this observational study. Demographic, clinical, and laboratory data were collected, and patients were divided into two groups: survivors and non-survivors. RESULTS Multivariate analysis demonstrated that lactate levels at 24 h after initiation of CRRT treatment, but not lactate levels at intensive care unit (ICU) admission, were associated with mortality. Lactate clearance was associated with lower mortality among the survivors (OR = 0.140) at 6 h after ICU admission and late mortality (OR = 0.260) after 24 h. The area under the ROC curves for mortality was 0.682 for initial lactate; 0.797 for lactate at 24 h; and 0.816 for lactate clearance at 24 h. CONCLUSIONS Our result reinforces that the determination of lactate dynamics represents a good predictor for mortality, and serial lactate measurements may be more useful prognostic markers than initial lactate in patients with septic shock.
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Affiliation(s)
- Cosmin Iosif Trebuian
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
- Department of Anesthesia and Intensive Care, Emergency County Hospital Resita, 320210 Resita, Romania
| | - Adina Maria Marza
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital Timisoara, 300079 Timisoara, Romania
| | - Raul Chioibaş
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
| | - Dumitru Şutoi
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
| | - Alina Petrica
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
- Emergency Department of “Pius Brinzeu”, Emergency Clinical County Hospital Timisoara, 300736 Timisoara, Romania
| | - Iulia Crintea-Najette
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital Timisoara, 300079 Timisoara, Romania
| | - Daian Popa
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital Timisoara, 300079 Timisoara, Romania
| | - Florin Borcan
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (F.B.); (D.F.)
| | - Daniela Flondor
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (F.B.); (D.F.)
- Research Center for Pharmaco-Toxicological Evaluation, Victor Babes University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Ovidiu Alexandru Mederle
- Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania; (C.I.T.); (A.M.M.); (D.Ş.); (A.P.); (I.C.-N.); (D.P.); (O.A.M.)
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Deng MX, Haller C, Moss K, Saha S, Runeckles K, Fan CPS, Langanecha B, Floh A, Guerguerian AM, Honjo O. Early outcomes of moderate-to-high-risk pediatric congenital cardiac surgery and predictors of extracorporeal circulatory life support requirement. Front Pediatr 2024; 12:1282275. [PMID: 38523837 PMCID: PMC10957634 DOI: 10.3389/fped.2024.1282275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Background Cardiopulmonary failure refractory to medical management after moderate-to-high-risk congenital cardiac surgery may necessitate mechanical support with veno-arterial extracorporeal membrane oxygenation (ECMO). On the extreme, ECMO can also be initiated in the setting of cardiac arrest (extracorporeal cardiopulmonary resuscitation, ECPR) unresponsive to conventional resuscitative measures. Methods This was a single-center retrospective cohort study of patients (n = 510) aged <3 years old who underwent cardiac surgery with cardiopulmonary bypass with a RACHS-1 score ≥3 between 2011 and 2014. Perioperative factors were reviewed to identify predictors of ECMO initiation and mortality in the operating room (OR) and the intensive care unit (ICU). Results A total of 510 patients with a mean surgical age of 10.0 ± 13.4 months were included. Among them, 21 (4%) patients received postoperative ECMO-12 were initiated in the OR and 9 in the ICU. ECMO cannulation was associated with cardiopulmonary bypass duration, aortopulmonary shunt, residual severe mitral regurgitation, vaso-inotropic score, and postprocedural lactate (p < 0.001). Of the 32 (6%) total deaths, 7 (22%) were ECMO patients-4 were elective OR cannulations and 3 were ICU ECPR. Prematurity [hazard ratio (HR): 2.61, p < 0.01), Norwood or Damus-Kaye-Stansel procedure (HR: 4.29, p < 0.001), postoperative left ventricular dysfunction (HR: 5.10, p = 0.01), residual severe tricuspid regurgitation (HR: 6.06, p < 0.001), and postoperative ECMO (ECPR: HR: 15.42, p < 0.001 vs. elective: HR: 5.26, p = 0.01) were associated with mortality. The two patients who were electively cannulated in the ICU survived. Discussion Although uncommon, postoperative ECMO in children after congenital cardiac surgery is associated with high mortality, especially in cases of ECPR. Patients with long cardiopulmonary bypass time, residual cardiac lesions, or increased vaso-inotropic requirement are at higher risk of receiving ECMO. Pre-emptive or early ECMO initiation before deterioration into cardiac arrest may improve survival.
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Affiliation(s)
- Mimi Xiaoming Deng
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christoph Haller
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kasey Moss
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Sudipta Saha
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Kyle Runeckles
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Chun-Po Steve Fan
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | | | - Alejandro Floh
- Department of Critical Care Medicine, Labatt Family Heart Centre, Toronto, ON, Canada
| | | | - Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Aksoy T, Arslan AH, Ugur M, Ustunsoy H. Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation. Braz J Cardiovasc Surg 2024; 39:e20230091. [PMID: 38426430 PMCID: PMC10903277 DOI: 10.21470/1678-9741-2023-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/05/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Findings of inadequate tissue perfusion might be used to predict the risk of mortality. In this study, we evaluated the effects of lactate and lactate clearance on mortality of patients who had undergone extracorporeal membrane oxygenation (ECMO). METHODS Patients younger than 18 years old and who needed venoarterial ECMO support after surgery for congenital heart defects, from July 2010 to January 2019, were retrospectively analyzed. Patients successfully weaned from ECMO constituted Group 1, and patients who could not be weaned from ECMO were in Group 2. Postoperative clinics and follow-ups of the groups including mortality and discharge rates were evaluated. RESULTS There were 1,844 congenital heart surgeries during the study period, and 55 patients that required ECMO support were included in the study. There was no statistically significant difference between the groups regarding demographics and operative variables. The sixth-, 12th-, and 24th-hour lactate levels in Group 1 were statistically significantly lower than those in Group 2 (P=0.046, P=0.024, and P<0.001, respectively). There were statistically significant differences regarding lactate clearance between the groups at the 24th hour (P=0.009). The cutoff point for lactate level was found as ≥ 2.9, with 74.07% sensitivity and 78.57% specificity (P<0.001). The cutoff point for lactate clearance was determined as 69.44%, with 59.26% sensitivity and 78.57% specificity (P=0.003). CONCLUSION Prognostic predictive factors are important to initiate advanced treatment modalities in patients with ECMO support. In this condition, lactate and lactate clearance might be used as a predictive marker.
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Affiliation(s)
- Tamer Aksoy
- Department of Anesthesiology and Reanimation, Anadolu Medical
Center, Kocaeli, Turkey
| | - Ahmet Hulisi Arslan
- Department of Cardiovascular Surgery, Anadolu Medical Center,
Kocaeli, Turkey
| | - Murat Ugur
- Department of Cardiovascular Surgery, University of Health
Sciences, Sancaktepe Sehit Professor Doctor Ilhan Varank Training and Research
Hospital, Istanbul, Turkey
| | - Hasim Ustunsoy
- Department of Cardiovascular Surgery, Anadolu Medical Center,
Kocaeli, Turkey
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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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Yang B, Hong X, Zhao Z, Liu Y, Zhang H, Feng Z. Positive association between arterial blood lactate level before extra-corporeal membrane oxygenation and 30-day mortality in pediatric patients with severe cardiopulmonary failure. Perfusion 2023:2676591231202369. [PMID: 37699199 DOI: 10.1177/02676591231202369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION This study aimed to investigate the relationship between blood lactate level and mortality in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) for severe cardiopulmonary failure. METHODS A retrospective observational study was conducted on pediatric patients who received ECMO from January 2013 to December 2021 at the Seventh Medical Center of PLA General Hospital. Patient demographic characteristics, arterial blood lactate level prior to ECMO (pre-ECMO), ECMO settings, ECMO duration, and 30-days mortality were retrieved from patients' medical records. The relationships between pre-ECMO blood lactate level and mortality were interpreted using the logistic regression analysis and Kaplan-Meier survival analysis. RESULTS A total of 160 pediatric patients who had either refractory respiratory failure (n = 89) or circulatory failure (n = 71) and received ECMO were included in this study. In both the respiratory failure and circulatory failure groups, the non-survivors showed a higher mean pre-ECMO arterial blood lactate level than the survivors. In the respiratory failure group, a pre-ECMO lactate concentration at ≥11.6 mmol/L had a sensitivity of 51% and a specificity of 82% for predicting mortality. In the circulatory failure group, a pre-ECMO lactate concentration at ≥7.2 mmol/L had a sensitivity of 90% and a specificity of 57% for predicting mortality. The Kaplan-Meier survival curves showed that respiratory failure patients with a pre-ECMO lactate level over 11.6 mmol/L or circulatory failure patients with a pre-ECMO lactate level over 7.2 mmol/L had a higher 30-days mortality rate than those with a lower lactate level. CONCLUSIONS High pre-ECMO arterial blood lactate level serves as an independent risk factor for mortality in pediatric patients who receive ECMO for severe cardiopulmonary failure.
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Affiliation(s)
- Baowang Yang
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaoyang Hong
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhe Zhao
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yingyue Liu
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huiling Zhang
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhichun Feng
- Pediatric Intensive Care Unit, Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
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Wang M, Wang Y, Taotao L, Zhao Q, Chao Y. Evaluation of plasma lactate parameters for predicting mortality of septic patients. Heliyon 2022; 8:e12340. [PMID: 36582701 PMCID: PMC9792805 DOI: 10.1016/j.heliyon.2022.e12340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Objective To compare the accuracy of serum lactate parameters, including lactate peak concentration (LACpeak), lactate time area (LACarea), and lactate clearance (LC) for predicting mortality of the septic patients, and to compare with the predictive accuracy of National Early Warning Score (NEWS) and Sequential Organ Failure Assessment (SOFA) scores. Methods This study retrospectively screened the septic patients admitted to the ICU in the Medical Information Mart for Intensive Care IV (MIMIC-IV) from 2008 to 2019. The baseline data and outcomes of patients were gathered. The subjects were divided into the non-survival group and the survival group. SOFA, NEWS, LACpeak, and LACarea were recorded. The LC was calculated 6 h after LACpeak. The above parameters were compared by the T-test and Mann-Whitney U test, and odds ratios were calculated adjusting for age and sex. The receiver operating characteristic curves (ROCs) of subjects were plotted according to SOFA, NEWS, LACpeak, and LACarea within 24h, and LC at 6h of ICU admission. The Areas under the ROC curve (AUCs), sensitivity, and specificity were compared with R version 4.1.1. Results 1,169 septic patients were involved, and 366 (31.3%) patients died within 28 days. Compared to the survival group, the LACpeak of the non-survival group was higher [4.85 (3.2, 7.9) vs. 3.4 (2.6, 5.25) mmol/L, adjusted odds ratio 1.18, P < 0.001], and the LACarea of the non-survivals was higher than the survivals too [18.44 (10.36, 27.63) vs. 13.65 (9.01, 21.73), adjusted odds ratio 1.03, P < 0.001)]. The LC of the survivals at 6 h after LACpeak was significantly higher than that of the non-survivals [0.26 (0.14.0.42) vs. 0.19 (0.10, 0.33), adjusted odds ratio 0.06, P < 0.01]. Within 24h of ICU admission, the AUCs of mortality prediction in descending order were NEWS [0.73 (0.70, 0.76)], SOFA [0.69 (0.66, 0.73)], LACpeak [0.64 (0.61, 0.68)], and LACarea [0.60 (0.56, 0.63)]. There were 204 patients with 6-hour LC after LACpeak the AUCs of LACarea, LACpeak and LC were 0.73(0.65, 0.80), 0.71(0.62,0.78) and 0.65 (0.56, 0.73), respectively. Conclusions The predictive accuracy of LC was not superior to LACpeak and LACarea for the mortality of the septic patients and the predictive value of all the above lactate parameters for mortality maybe not better than SOFA and NEWS.
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Affiliation(s)
- Mei Wang
- Department of Intensive Care Unit, The First Hospital of Tsinghua University, Beijing 100016, China
| | - Yan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Liu Taotao
- Department of Surgical Intensive Care Unit, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Qinyu Zhao
- College of Engineering and Computer Science, Australian National University, Canberra 2600, Australia
| | - Yangong Chao
- Department of Intensive Care Unit, The First Hospital of Tsinghua University, Beijing 100016, China,Corresponding author.
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Sandal ÖS, Ceylan G, Sarı F, Atakul G, Çolak M, Topal S, Soydan E, Karaarslan ÜU, Ağın H. Could lactate clearance be a marker of mortality in pediatric intensive care unit? Turk J Med Sci 2022; 52:1771-1778. [PMID: 36945991 PMCID: PMC10390184 DOI: 10.55730/1300-0144.5522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hyperlactatemia is a common finding in critically ill patients and has significant prognostic implications. However, a single lactate measurement has not been correlated to mortality consistently. In this study, we aimed to correlate the clinical efficacy of lactate clearance for the prediction of mortality in pediatric intensive care unit patients. METHODS This retrospective observational study was performed in the pediatric intensive care unit in patients with lactate level >3 mmol/lt. Initial, 6th h, and 24th h lactate levels were recorded and lactate clearance was calculated using these values (lactate level at admission - level 6 h later × 100/lactate level at admission). RESULTS A total of 172 patients were included in the study. Forty-four out of 172 patients died. Median (IQR) lactate (mmol/L) at admission was low in those who survived in comparison to nonsurvivors 4.4 (3.1) vs. 5.75 (7.7) (p = 0.002). Clearance at 6th h was significantly lower in those who died (11.7%) than those who survived (36.7) (p = 0.001). 6th h lactate clearance level <20.7% predicted mortality with a sensitivity of 63.6% and specificity of 69.5% along with a positive predictive value of 41.8 and a negative predictive value of 84.8 (p = 0.004). Both lactate levels and lactate clearance values were significantly predictive factors for mortality (p < 0.05). Only a positive moderate correlation was found between the percentage of PRISM-IV % and 6th h lactate level. DISCUSSION The present study revealed that lactate clearance is a simple and rapid risk-stratification tool holding to be a potential biomarker of managing the treatment efficacy of children in the pediatric intensive care unit.
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Affiliation(s)
- Özlem Saraç Sandal
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Gökhan Ceylan
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Ferhat Sarı
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Gülhan Atakul
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Mustafa Çolak
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Sevgi Topal
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Ekin Soydan
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Ünal Utku Karaarslan
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Hasan Ağın
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
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Jin Y, Gao P, Zhang P, Bai L, Li Y, Wang W, Feng Z, Wang X, Liu J. Mortality prediction in pediatric postcardiotomy veno-arterial extracorporeal membrane oxygenation: A comparison of scoring systems. Front Med (Lausanne) 2022; 9:967872. [PMID: 35991647 PMCID: PMC9386139 DOI: 10.3389/fmed.2022.967872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/20/2022] [Indexed: 12/05/2022] Open
Abstract
Background Pediatric postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients have high mortality and morbidity. There are currently three scoring systems available to predict mortality: the Pediatric Extracorporeal Membrane Oxygenation Prediction (PEP) model, Precannulation Pediatric Survival After VA-ECMO (Pedi-SAVE) score, and Postcannulation Pedi-SAVE score. These methods provide risk stratification scores for pediatric patients requiring ECMO for cardiac support. However, comparative validation of these scoring systems remains scarce. We aim to assess the ability of these models to predict outcomes in a cohort of pediatric patients undergoing VA-ECMO after cardiac surgery, and identify predictors of in-hospital mortality. Methods A retrospective analysis of 101 children admitted to Fuwai Hospital who received VA-ECMO from January 1, 2010 to December 31, 2020 was performed. Patients were divided into two groups, survivors (n = 49) and non-survivors (n = 52) according to in-hospital mortality. PEP model and Pedi-SAVE scores were calculated. The primary outcomes were the risk factors of in-hospital mortality, and the ability of the PEP model, Precannulation Pedi-SAVE and Postcannulation Pedi-SAVE scores to predict in-hospital mortality. Results Postcannulation Pedi-SAVE score accessing the entire ECMO process had the greatest area under receiver operator curve (AUROC), 0.816 [95% confidence interval (CI): 0.733–0.899]. Pre-ECMO PEP model could predict in-hospital mortality [AUROC = 0.691 (95% CI: 0.565–0.817)], and Precannulation Pedi-SAVE score had the poorest prediction [AUROC = 0.582(95% CI: 0.471–0.694)]. Lactate value at ECMO implantation [OR = 1.199 (1.064–1.351), P = 0.003] and infectious complications [OR = 5.169 (1.652–16.172), P = 0.005] were independent risk factors for in-hospital mortality. Conclusion Pediatric cardiac ECMO scoring systems, including multiple risk factors before and during ECMO, were found to be useful in this cohort. Both the pre-ECMO PEP model and the Postcannulation Pedi-SAVE score were found to have high predictive value for in-hospital mortality in pediatric postcardiotomy VA-ECMO.
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Affiliation(s)
- Yu Jin
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peng Gao
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peiyao Zhang
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liting Bai
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yixuan Li
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenting Wang
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyi Feng
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Wang
- Department of Pediatric Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinping Liu
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Jinping Liu
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