Plasma lactate level may be an insufficient monitoring tool in critically ill patient: A case of ischemia modified albumin in acute glyphosate poisoning

2013 ◽  
Vol 221 ◽  
pp. S66-S67
Author(s):  
Byungho Choi ◽  
Changhwan Sohn ◽  
SeungMok Ryoo ◽  
Sangwook Ha ◽  
Rubi Jung ◽  
...  
Keyword(s):  
Critically Ill ◽  
Lactate Level ◽  
Critically Ill Patient ◽  
Plasma Lactate ◽  
Monitoring Tool ◽  
Ischemia Modified Albumin ◽  
Plasma Lactate Level

scholarly journals Use of plasma lactate level to predict 28-day mortality in non-elderly and elderly sepsis patients based on the MIMIC-III database

2020 ◽  
Author(s):  
Yihua Dong ◽  
Xiaoyang Miao ◽  
Yufeng Hu ◽  
Yueyue Huang ◽  
Jie Chen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Elderly Patients ◽  
Lactate Level ◽  
Regression Models ◽  
Logistic Regression Model ◽  
Plasma Lactate ◽  
Logistic Regression Models ◽  
Lactate Levels ◽  
Plasma Lactate Level

Abstract Purpose: We co mpared the use of lactate level for predicting 28-day mortality in non-elderly (<65 years) and elderly (≥65 years) sepsis patients who were admitted to an intensive care unit (ICU). A multivariate logistic regression model was established to predict 28-day mortality for each group. Methods: This retrospective study used the Medical Information Mart for Intensive Care Ⅲ, a publicly available database of ICUs. Eligible sepsis patients were at least 18 years-old, hospitalized for at least 24 h, and had lactate levels measured in the ICU. Univariate logistic regression analysis and step-wise multivariable logistic regression models were used to identify factors associated with 28-day mortality. Results: The 28-day mortality was 30.9% among the 2482 patients, and was significantly greater in elderly than non-elderly patients. Within each age group, the lactate level was greater for non-survivors than survivors. Among non-survivors, the lactate level was significantly higher for the non-elderly than the elderly. Adjusted logistic regression analysis showed that non-elderly patients with lactate levels of 2.0–4.0 mmol/L and above 4.0 mmol/L had greater risk of death than those with normal lactate levels. For all patients, the stepwise logistic regression model had an area under the receiver operating curve (AUROC) of 0.752; for non-elderly patients, the model had an AUROC of 0.793; for elderly patients, the model had an AUROC of 0.711. The Hosmer-Lemeshow test indicated acceptable goodness-of-fit for each group (P=0.206, P=0.646, and P= 0.482, respectively). Conclusion: In our population of sepsis patients, the lactate level was about 0.9 mmol/L lower in elderly non-survivors than non-elderly survivors. A plasma lactate level above 2.0 mmol/L was an independent risk factor for death at 28-days among non-elderly patients. Our logistic regression models effectively predicted 28-day mortality of sepsis patients in different age groups.

Lactic Acidemia in Reye's Syndrome

PEDIATRICS ◽  
1982 ◽  
Vol 69 (1) ◽  
pp. 64-69
Author(s):  
James H. Tonsgard ◽  
Peter R. Huttenlocher ◽  
Ronald A. Thisted
Keyword(s):  
Lactate Level ◽  
Clinical Stage ◽  
Ammonia Level ◽  
Clinical State ◽  
Plasma Lactate ◽  
Reye's Syndrome ◽  
Metabolic Component ◽  
Lactate Levels ◽  
Lactic Acidemia ◽  
Plasma Lactate Level

Plasma lactate level was measured in 21 patients with Reye's syndrome and was compared with neurologic state as rated on a simple coma scale. Significant elevations in plasma lactate, ranging from 2 to 15 mEq/liter, were noted in all patients. There was a close correspondence between stage of coma at the time the sample was drawn and lactate levels. The correlation of plasma lactate level with clinical stage could not be accounted for by differences in glucose, Po2, Pco2, pH, blood pressure, or serum osmolality. In contrast, blood ammonia level correlated with the severity of the encephlopathy early in the course only and often returned to normal in patients with persistent coma. Other measurements of hepatic dysfunction such as SGOT and SGPT levels failed to correlate with clinical state. All patients had a metabolic acidosis; in five patients it was uncompensated. Lactate accounted for nearly all (mean 81%) of the observed base deficit. The findings suggest that lactic acidemia is an important metabolic component of Reye's syndrome.

scholarly journals Haemodynamic Monitoring Using Echocardiography in the Critically Ill: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Michelle S. Chew
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Systematic Study ◽  
Right Ventricular Function ◽  
Critically Ill Patient ◽  
Haemodynamic Monitoring ◽  
Monitoring Tool ◽  
Therapeutic Impact ◽  
Echocardiographic Study ◽  
Left And Right

Physicians caring for the critically ill are now expected to acquire competence in echocardiography. It has become an indispensable diagnostic and monitoring tool in acute care settings where it is generally accepted to have therapeutic impact. There are a number of indications for a critical care echocardiographic study, and the most important queries include those pertaining left and right ventricular function and filling status. Focused examinations are increasing in popularity and provide a means for systematic study, and can be easily learned and practiced by novices. This paper addresses the indications, therapeutic impact, and some of the most common questions that can be answered using echocardiography the in critically ill patient.

A pilot project informing the design of a web-based dynamic nomogram in order to predict survival one year after hip fracture surgery (Preprint)

2021 ◽  
Author(s):  
Graeme McLeod ◽  
Iain Kennedy ◽  
Eilidh Simpson ◽  
Judith Joss ◽  
Katriona Goldmann
Keyword(s):  
Hip Fracture ◽  
Lactate Level ◽  
Data Entry ◽  
Cox Proportional Hazards Model ◽  
Plasma Lactate ◽  
Web Based ◽  
Hip Fracture Surgery ◽  
Prediction Of Survival ◽  
Fracture Surgery ◽  
Plasma Lactate Level

BACKGROUND Hip fracture is associated with high mortality. Identification of individual risk informs anesthetic and surgical decision making and can reduce the risk of death. However, interpretation of data, and application of research findings can be difficult, and there is a need to simplify risk indices for clinicians and lay-people alike. Results Twenty-four (7.3%) patients died within 30 days, 65 (19.8%) within 120 days and 94 (28.6%) within 365 days of surgery. Independent predictors of mortality common to all models were admission Age, BMI, and creatinine, lactate and their combination. Age and BMI inversely correlated with mortality. Presentation with a creatinine level of 90 mol.L-1 increased the odds of death OR 2.9 (1.4 - 6.0) 365 days after surgery compared to an admission level of 60 mol. L-1 Presentation with a plasma lactate level of 2 mmol. L-1 increased the odds of death OR 2.2 (1.1 - 4.5) 365 days after surgery compared to a plasma lactate level of 1 mmol. L-1. Patients presenting to hospital with a BMI of 30 kg.m-2 were less likely to die within 365 days OR 0.41 (0.17 - 0.99) after surgery compared to patients with a BMI of 20 kg.m-2. We presented four models in Shiny. Data entry created Kaplan-Meier graphs and outcome measures (95%CI). Conclusion We developed easy to read and interpretable web-based nomograms for prediction of survival after hip fracture surgery. OBJECTIVE Our primary objective was to develop a web-based nomogram for prediction of survival 365 days after fracture hip surgery. METHODS We collected data from 329 patients up to 365 days after hip fracture surgery and built four models using packages in RStudio. A global Cox Proportional Hazards Model was developed from all covariates. Covariates included sex, age, BMI, white cell count, lactate, creatinine, hemoglobin, C-reactive protein, ASA status, socio-economic status, duration of surgery, total time in the operating room, side of surgery and procedure urgency. We also developed a Cox proportional hazards model (CPH). a logistic regression model (LRM), and a generalized linear model (GLM) for binomial response data using iterative data reduction and elimination. We wrote an app in Shiny in order to present the models in a user-friendly way. The app consists of a drop-down box for model selection, horizontal sliders for data entry, model summaries, and prediction and survival plots. A slider selects patient follow-up over 365 days. RESULTS Twenty-four (7.3%) patients died within 30 days, 65 (19.8%) within 120 days and 94 (28.6%) within 365 days of surgery. Independent predictors of mortality common to all models were admission Age, BMI, and creatinine, lactate and their combination. Age and BMI inversely correlated with mortality. Presentation with a creatinine level of 90 mol.L-1 increased the odds of death OR 2.9 (1.4 - 6.0) 365 days after surgery compared to an admission level of 60 mol. L-1 Presentation with a plasma lactate level of 2 mmol. L-1 increased the odds of death OR 2.2 (1.1 - 4.5) 365 days after surgery compared to a plasma lactate level of 1 mmol. L-1. Patients presenting to hospital with a BMI of 30 kg.m-2 were less likely to die within 365 days OR 0.41 (0.17 - 0.99) after surgery compared to patients with a BMI of 20 kg.m-2. We presented four models in Shiny. Data entry created Kaplan-Meier graphs and outcome measures (95%CI). CONCLUSIONS We developed easy to read and interpretable web-based nomograms for prediction of survival after hip fracture surgery. CLINICALTRIAL Nil

scholarly journals Use of plasma lactate level to predict 28-day mortality in non-elderly and elderly sepsis patients based on the MIMIC-III database

2019 ◽  
Author(s):  
Yihua Dong ◽  
Xiaoyang Miao ◽  
Yufeng Hu ◽  
Yueyue Huang ◽  
Jie Chen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Elderly Patients ◽  
Lactate Level ◽  
Medical Information ◽  
Characteristic Curve ◽  
Age Group ◽  
Plasma Lactate ◽  
Risk Of Death ◽  
Lactate Levels ◽  
Plasma Lactate Level

Abstract Purpose We compared the use of lactate level for predicting 28-day mortality in non-elderly (<65 years) and elderly (≥65 years) sepsis patients who were admitted to an intensive care unit (ICU). Methods This retrospective study used the Medical Information Mart for Intensive Care III, a publicly available database of ICUs. Eligible sepsis patients were at least 18 years-old, hospitalized for at least 24 h, and had lactate levels measured in the ICU. The relationship of lactate level with 28-day mortality was determined. Results The 28-day mortality was 30.9% among the 2482 patients, and was significantly greater in elderly than non-elderly patients. Within each age group, the lactate level was greater for non-survivors than survivors. Among non-survivors, the lactate level was significantly higher for the non-elderly than the elderly. Adjusted logistic regression analysis showed that elderly and non-elderly patients with lactate levels of 2.0–4.0 mmol/L and above 4.0 mmol/L had greater risk of death than those with normal lactate. Cirrhosis, chronic renal failure, and malignancy were independent risk factors for 28-day mortality in each age group. Based on a lactate cut-off level of 2.1 mmol/L, the area under the receiver operating characteristic curve was 0.628 (overall), 0.707 (non-elderly), and 0.585 (elderly). Conclusion In our population of sepsis patients, a plasma lactate level above 2.0 mmol/L was an independent risk factor for death at 28-days. The lactate level among elderly non-survivors was about 0.9 mmol/L lower than among non-elderly survivors. Lactate was a better prognostic indicator for non-elderly than elderly patients.

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