Maryna Masyuk1,2, Bernhard Wernly3, Michael Lichtenauer3, Marcus Franz4, Bjoern Kabisch4, Johanna M Muessig1,2, Georg Zimmermann5,6,7, Alexander Lauten8,9, P Christian Schulze4, Uta C Hoppe3, Malte Kelm1,2, Jan Bakker10,11,12,13, Christian Jung14,15. 1. Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany. 2. CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany. 3. Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria. 4. Department of Cardiology, Clinic of Internal Medicine I, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany. 5. Department of Neurology, Christian Doppler Clinic and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria. 6. Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria. 7. Department of Mathematics, Paris Lodron University, Salzburg, Austria. 8. Department of Cardiology, Charité, University Hospital Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. 9. German Center for Cardiovascular Research (DZHK), University Heart Center, Charitéplatz 1, 10117, Berlin, Germany. 10. Department of Intensive Care Adults, Erasmus MC University Medical Center, 3000 CA, Rotterdam, The Netherlands. 11. Department of Pulmonology and Critical Care, New York University Medical Center, New York, 10022, NY, USA. 12. Department of Pulmonology and Critical Care, Columbia University Medical Center, NY, 10032, NY, USA. 13. Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile. 14. Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany. christian.jung@med.uni-duesseldorf.de. 15. CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany. christian.jung@med.uni-duesseldorf.de.
Abstract
PURPOSE: Changes of lactate concentration over time were reported to be associated with survival in septic patients. We aimed to evaluate delta-lactate (ΔLac) 24 h after admission (Δ24Lac) to an intensive care unit (ICU) in critically ill patients for short- and long-term prognostic relevance. METHODS: In total, 26,285 lactate measurements of 2191 patients admitted to a German ICU were analyzed. Inclusion criterion was a lactate concentration at admission above 2.0 mmol/L. Maximum lactate concentrations of day 1 and day 2 were used to calculate Δ24Lac. Follow-up of patients was performed retrospectively. Association of Δ24Lac and both in-hospital and long-term mortality were investigated. An optimal cut-off was calculated by means of the Youden index. RESULTS: Patients with lower Δ24Lac were of similar age, but clinically sicker. As continuous variable, higher Δ24Lac was associated with decreased in-hospital mortality (per 1% Δ24Lac; HR 0.987 95%CI 0.985-0.990; p < 0.001) and an optimal Δ24Lac cut-off was calculated at 19%. Δ24Lac ≤ 19% was associated with both increased in-hospital (15% vs 43%; OR 4.11; 95%CI 3.23-5.21; p < 0.001) and long-term mortality (HR 1.54 95%CI 1.28-1.87; p < 0.001), even after correction for APACHE II, need for catecholamines and intubation. We matched 256 patients with Δ24Lac ≤ 19% to case-controls > 19% corrected for APACHE II scores, baseline lactate level and sex: Δ24Lac ≤ 19% remained associated with lower in-hospital and long-term survival. CONCLUSIONS: Lower Δ24Lac was robustly associated with adverse outcome in critically ill patients, even after correction for confounders. Δ24Lac might constitute an independent, easily available and important parameter for risk stratification in the critically ill.
PURPOSE: Changes of lactate concentration over time were reported to be associated with survival in septic patients. We aimed to evaluate delta-lactate (ΔLac) 24 h after admission (Δ24Lac) to an intensive care unit (ICU) in critically illpatients for short- and long-term prognostic relevance. METHODS: In total, 26,285 lactate measurements of 2191 patients admitted to a German ICU were analyzed. Inclusion criterion was a lactate concentration at admission above 2.0 mmol/L. Maximumlactate concentrations of day 1 and day 2 were used to calculate Δ24Lac. Follow-up of patients was performed retrospectively. Association of Δ24Lac and both in-hospital and long-term mortality were investigated. An optimal cut-off was calculated by means of the Youden index. RESULTS:Patients with lower Δ24Lac were of similar age, but clinically sicker. As continuous variable, higher Δ24Lac was associated with decreased in-hospital mortality (per 1% Δ24Lac; HR 0.987 95%CI 0.985-0.990; p < 0.001) and an optimal Δ24Lac cut-off was calculated at 19%. Δ24Lac ≤ 19% was associated with both increased in-hospital (15% vs 43%; OR 4.11; 95%CI 3.23-5.21; p < 0.001) and long-term mortality (HR 1.54 95%CI 1.28-1.87; p < 0.001), even after correction for APACHE II, need for catecholamines and intubation. We matched 256 patients with Δ24Lac ≤ 19% to case-controls > 19% corrected for APACHE II scores, baseline lactate level and sex: Δ24Lac ≤ 19% remained associated with lower in-hospital and long-term survival. CONCLUSIONS: Lower Δ24Lac was robustly associated with adverse outcome in critically illpatients, even after correction for confounders. Δ24Lac might constitute an independent, easily available and important parameter for risk stratification in the critically ill.
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