Bernhard Wernly1, Nadia Heramvand2, Maryna Masyuk2, Richard Rezar3, Raphael Romano Bruno2, Malte Kelm4, David Niederseer5, Michael Lichtenauer3, Uta C Hoppe3, Jan Bakker6, Christian Jung7. 1. Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria; Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 2. Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. 3. Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria. 4. Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. 5. Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 6. Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Pulmonology and Critical Care, New York University Medical Center, New York, USA; Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, USA; Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile. 7. Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. Electronic address: christian.jung@med.uni-duesseldorf.de.
Abstract
RATIONALE AND OBJECTIVES: Acidosis and hyperlactatemia predict outcome in critically ill patients. We assessed BE and pH for risk prediction capabilities in a sub-group of septic patients in the MIMIC-III database. METHODS: Associations with mortality were assessed by logistic regression analysis in 5586 septic patients. Baseline parameters, lactate concentrations, pH, and BE were analyzed at baseline and after 6 hours. MEASUREMENTS AND MAIN RESULTS: We combined acidosis (defined as either BE ≤-6 and/or pH ≤7.3) and hyperlactatemia and split the cohort into three subgroups: low-risk (no acidosis and lactate <2.3 mmol/L; n = 2294), medium-risk (either acidosis or lactate >2.3 mmol/L; n = 2125) and high-risk (both acidosis and lactate >2.3 mmol/L; n = 1167). Mortality was 14%, 20% and 38% (p<0.001) in low-risk, medium-risk and high-risk patients, respectively. The predictiveness of this model (AUC 0.63 95%CI 0.61-0.65) was higher compared to acidosis (AUC 0.59 95%CI 0.57-0.61; p<0.001) and lactate >2.3 mmol/L (AUC 0.60 95%CI 0.58-0.62; p<0.001) alone. Hyperlactatemia alone was only moderately predictive for acidosis (AUC 0.60 95%CI 0.59-0.62). CONCLUSIONS: Acidosis and hyperlactatemia can occur independently to a certain degree. Combining acidosis and hyperlactatemia in a model yielded higher predictiveness for ICU-mortality. Septic patients with acidosis should be treated even more aggressively in the future.
RATIONALE AND OBJECTIVES:Acidosis and hyperlactatemia predict outcome in critically illpatients. We assessed BE and pH for risk prediction capabilities in a sub-group of septic patients in the MIMIC-III database. METHODS: Associations with mortality were assessed by logistic regression analysis in 5586 septic patients. Baseline parameters, lactate concentrations, pH, and BE were analyzed at baseline and after 6 hours. MEASUREMENTS AND MAIN RESULTS: We combined acidosis (defined as either BE ≤-6 and/or pH ≤7.3) and hyperlactatemia and split the cohort into three subgroups: low-risk (no acidosis and lactate <2.3 mmol/L; n = 2294), medium-risk (either acidosis or lactate >2.3 mmol/L; n = 2125) and high-risk (both acidosis and lactate >2.3 mmol/L; n = 1167). Mortality was 14%, 20% and 38% (p<0.001) in low-risk, medium-risk and high-risk patients, respectively. The predictiveness of this model (AUC 0.63 95%CI 0.61-0.65) was higher compared to acidosis (AUC 0.59 95%CI 0.57-0.61; p<0.001) and lactate >2.3 mmol/L (AUC 0.60 95%CI 0.58-0.62; p<0.001) alone. Hyperlactatemia alone was only moderately predictive for acidosis (AUC 0.60 95%CI 0.59-0.62). CONCLUSIONS:Acidosis and hyperlactatemia can occur independently to a certain degree. Combining acidosis and hyperlactatemia in a model yielded higher predictiveness for ICU-mortality. Septic patients with acidosis should be treated even more aggressively in the future.
Authors: Raphael Romano Bruno; Bernhard Wernly; Behrooz Mamandipoor; Richard Rezar; Stephan Binnebössel; Philipp Heinrich Baldia; Georg Wolff; Malte Kelm; Bertrand Guidet; Dylan W De Lange; Daniel Dankl; Andreas Koköfer; Thomas Danninger; Wojciech Szczeklik; Sviri Sigal; Peter Vernon van Heerden; Michael Beil; Jesper Fjølner; Susannah Leaver; Hans Flaatten; Venet Osmani; Christian Jung Journal: Front Med (Lausanne) Date: 2021-07-09
Authors: Diego E Gomez; Sofia Bedford; Shannon Darby; Megan Palmisano; Robert J MacKay; David L Renaud Journal: J Vet Intern Med Date: 2020-11-03 Impact factor: 3.333
Authors: Thomas Danninger; Richard Rezar; Behrooz Mamandipoor; Daniel Dankl; Andreas Koköfer; Christian Jung; Bernhard Wernly; Venet Osmani Journal: Wien Klin Wochenschr Date: 2021-09-16 Impact factor: 1.704