Utility of the Lactate/Albumin Ratio as a Predictor for Mortality in Necrotizing Fasciitis Patients

Background. The lactate/albumin (L/A) ratio has been proposed as a prognostic marker because the ratio is associated with multiple organ failure and mortality in critically ill patients. We aimed to investigate the clinical utility of the L/A ratio as a good prognostic indicator of mortality in a cohort of necrotizing fasciitis patients. Method. This retrospective study was conducted in two tertiary hospitals in Taiwan between 2015 and 2020. We reviewed adult patients with measured serum lactate and albumin on the emergency department (ED) arrival to evaluate the prognostic performance of the lactate and lactate/albumin (L/A) ratio for outcome prediction. Result. Of the 262 NF patients, 20 (7.63%) died in the hospital. The area under the receiver operating characteristic curve (AUROC) value of the L/A ratio (0.76, 95% confidence interval [CI] 0.69–0.81, P < 0.01 ) was higher than lactate alone (0.71, 95% CI 0.65–0.74 P < 0.01 ) for predicting in-hospital mortality. The optimal cutoff of the L/A ratio was 1.61. The AUROC value of the L/A ratio was better than lactate alone regardless of normal lactate level. The cutoff of L/A ratio and hypoalbuminemia showed further discriminative value for in-hospital mortality even in patients with normal lactate levels. Conclusion. The prognostic performance of the L/A ratio was superior to a single measurement of lactate for predicting in-hospital mortality and intensive care unit (ICU) lengths in necrotizing fasciitis patients. Aggressive intervention and intensive care were necessary for high-risk NF patients upon ED arrival.

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Serum Lactate as an Independent Predictor of In-Hospital Mortality in Intensive Care Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066619854355 ◽

2019 ◽

Vol 35 (11) ◽

pp. 1257-1264 ◽

Cited By ~ 2

Author(s):

Ralphe Bou Chebl ◽

Hani Tamim ◽

Gilbert Abou Dagher ◽

Musharaf Sadat ◽

Farhan Al Enezi ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Normal Level ◽

Lactate Level ◽

Serum Lactate ◽

Lengths Of Stay ◽

Mechanical Ventilation Duration ◽

Lactate Levels ◽

High Lactate

Purpose: The aim of this study was to check if serum lactate was independently associated with mortality among critically ill patients. Materials and Methods: This was a single-center, retrospective cohort study. All adult patients (>18 years of age) who had at least 1 measurement of lactate within 24 hours of admission to intensive care unit (ICU) between January 2002 and December 2017 were included in the analysis. Patients were stratified into 3 groups: those with a serum lactate of <2 mmol/L (normal level), 2 to 4 mmol/L (intermediate level), and >4 mmol/L (high level). The primary outcome was in-hospital mortality. Secondary outcomes included ICU and hospital lengths of stay and mechanical ventilation duration. To determine the association between lactate level and hospital mortality, bivariate and multivariate logistic regression analyses were performed. Results: Of the 16,447 patients admitted to the ICU, 8167 (49.65%) had normal levels, 4648 (28.26%) had an intermediate, and 3632 (22.09%) had high lactate levels. Hospital mortality was the highest in high lactate level, followed by the intermediate and the normal level group (47.4% vs 26.5% vs 19.6%; P < .0001). Intermediate and high lactate levels were independent predictors of hospital mortality (odds ratio [OR], 1.32; 95% confidence interval [CI]: 1.20-1.46, and 1.94; 95% CI, 1.75-2.16, respectively) as well as ICU mortality (OR, 1.47; 95% CI, 1.30-1.66 and 2.56; 95% CI, 2.27-2.88, respectively). Conclusions: Intensive care unit serum lactate is associated with increased ICU and hospital mortality, independent of comorbidities, organ dysfunction, or hemodynamic status.

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COVID-19 in-hospital mortality of a secondary care center of Mexico City in a marginated area during the first months of the Mexican epidemic

10.21203/rs.3.rs-384455/v4 ◽

2021 ◽

Author(s):

José Martín Alanís-Naranjo ◽

Víctor Manuel Anguiano-Álvarez ◽

Eduardo Federico Hammeken-Larrondo

Keyword(s):

Intensive Care ◽

Hospital Mortality ◽

Mexico City ◽

Secondary Care ◽

Care Center ◽

Severe Pneumonia ◽

P Value ◽

Intravenous Antibiotics ◽

Tertiary Hospitals ◽

Hospital Acquired

Abstract Introduction: Low socioeconomic conditions and hospital saturation have been associated with higher mortality rates in hospitalized patients with COVID-19. Mexico City has become the country’s highest death toll. Iztapalapa is the district with the highest population density and marginalization in Mexico City. Most of the information on COVID-19 in-hospital mortality in Mexico comes from intensive care units or tertiary hospitals without considering the level of income. Data regarding hospital mortality in care centers with low availability of intensive care beds has not been explored.Material and methods: A retrospective cohort study in consecutive patients with COVID-19 hospitalized managed outside the intensive care unit in a secondary care center in Mexico City from April 1st, 2020, to May 31st, 2020. Analysis was performed between subgroups with a p-value <0.05 considered statistically significant.Results: A total of 164 patients were recruited; the median age was 52.5 years (IQR 44 - 64.5), 68% were males, 48.7% were obese, and 59.7% had comorbidities. Among those patients, 67% required mechanical ventilation and 32.3% vasopressor support. In this population, 52 recovered (31.7%) and 112 died (68.3%). The main risk factors associated with death were male sex, age > 50 years, diabetes, severe pneumonia on admission, PORT / PSI > 91, SMART-COP > 5, SCAP score > 10, dyspnea on admission, fever during hospitalization [p <0.05] and the administration of intravenous antibiotics [RR 3.45, 95% CI 1.69-7.06, p <0.001].Conclusion: In this study, we found higher in-hospital mortality compared to previous reports. We suggest that the administration of intravenous antibiotics could impact patient survival for the risk of developing hospital-acquired infections.

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Relative Hyperlactatemia in the Emergency Department: A Retrospective Cohort Study

10.21203/rs.3.rs-31886/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Ralphe Bou Chebl ◽

Sarah Jamali ◽

Nancy Mikati ◽

Reem Al Assaad ◽

Karim Abdel Daem ◽

...

Keyword(s):

Emergency Department ◽

Hospital Mortality ◽

Lactate Level ◽

Reference Range ◽

Serum Lactate ◽

Optimal Cutoff ◽

The Mean ◽

Emergency Department Patients ◽

Lactate Levels ◽

Youden’S Index

Abstract Objective The clinical interpretation of lactate ≤ 2.00 mmol/L in emergency department (ED) patients is not well characterized. This study aims to determine the optimal cutoff value for lactate within the reference range that predicts in-hospital mortality among ED patients with initial serum lactate levels within the reference range. Methods This was a retrospective study of adult patients presenting to a tertiary ED between the dates of January 1, 2014 and June 30, 2019 with an initial serum lactate level less than 2.00 mmol/L. The primary outcome was in-hospital mortality. Youden’s index was utilized to determine the optimal threshold that predicts mortality. Patients above the threshold were labeled as having relative hyperlactatemia. A multivariate logistic regression was performed to determine the association between relative hyperlactatemia and in-hospital mortality. Subgroup analyses were done to further examine the interaction between relative hyperlactatemia and hospital mortality. Results During the study period, 1638 patients were included. The mean age was 66.9 ± 18.6 years, 47.1% of the population were female, and the most prevalent comorbidity was hypertension (56.7%). The mean lactate level at presentation was 1.5 ± 0.3 mmol/L. In-hospital mortality was 3.8% in the overall population and 16.2% were admitted to the ICU. A lactate of 1.33 mmol/L was found to be the optimal cutoff that best discriminates between survivors and non-survivors. Relative hyperlactatemia was an independent predictor of in-hospital mortality (OR 1.78 CI1.18-4.03; p 0.02). Finally, Relative hyperlactatemia was associated with increased mortality in patients without hypertension (4.7% versus 1.1%; p 0.008), as well as patients without diabetes or COPD. Conclusion The optimal cutoff of initial serum lactate that discriminates between survivors and non-survivors is in the ED 1.33 mmol/L. Relative hyperlactatemia is associated with increased mortality in emergency department patients, and this interaction seems to be more important in healthy patients.

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Mortality Prediction in Cerebral Hemorrhage Patients Using Machine Learning Algorithms in Intensive Care Units

Frontiers in Neurology ◽

10.3389/fneur.2020.610531 ◽

2021 ◽

Vol 11 ◽

Author(s):

Ximing Nie ◽

Yuan Cai ◽

Jingyi Liu ◽

Xiran Liu ◽

Jiahui Zhao ◽

...

Keyword(s):

Machine Learning ◽

Intensive Care ◽

Random Forest ◽

Hospital Mortality ◽

Intensive Care Units ◽

Cerebral Hemorrhage ◽

Characteristic Curve ◽

Learning Algorithms ◽

Mortality Prediction ◽

Machine Learning Algorithms

Objectives: This study aims to investigate whether the machine learning algorithms could provide an optimal early mortality prediction method compared with other scoring systems for patients with cerebral hemorrhage in intensive care units in clinical practice.Methods: Between 2008 and 2012, from Intensive Care III (MIMIC-III) database, all cerebral hemorrhage patients monitored with the MetaVision system and admitted to intensive care units were enrolled in this study. The calibration, discrimination, and risk classification of predicted hospital mortality based on machine learning algorithms were assessed. The primary outcome was hospital mortality. Model performance was assessed with accuracy and receiver operating characteristic curve analysis.Results: Of 760 cerebral hemorrhage patients enrolled from MIMIC database [mean age, 68.2 years (SD, ±15.5)], 383 (50.4%) patients died in hospital, and 377 (49.6%) patients survived. The area under the receiver operating characteristic curve (AUC) of six machine learning algorithms was 0.600 (nearest neighbors), 0.617 (decision tree), 0.655 (neural net), 0.671(AdaBoost), 0.819 (random forest), and 0.725 (gcForest). The AUC was 0.423 for Acute Physiology and Chronic Health Evaluation II score. The random forest had the highest specificity and accuracy, as well as the greatest AUC, showing the best ability to predict in-hospital mortality.Conclusions: Compared with conventional scoring system and the other five machine learning algorithms in this study, random forest algorithm had better performance in predicting in-hospital mortality for cerebral hemorrhage patients in intensive care units, and thus further research should be conducted on random forest algorithm.

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Role of Arterial Serum Lactate as a Predictor of Undifferentiated Shock on Admission and its Outcome- A Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49761.15384 ◽

2021 ◽

Author(s):

Avadhesh Kumar Sharma ◽

Nandakumar Beke ◽

Dattatray Patki ◽

Arun Bahulikar ◽

Deepak Sadashiv Phalgune

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Lactate Level ◽

Serum Lactate ◽

Research Centre ◽

Secondary Outcome ◽

P Value ◽

Serum Lactate Level ◽

Icu Stay ◽

Lactate Levels

Introduction: Patients with elevated serum lactate levels may be at risk for considerable morbidity and mortality and require a prompt, thoughtful and systematic approach for diagnosis and treatment. Aim: To find an association of on admission arterial serum lactate with outcome in Intensive Care Unit (ICU) patients. Materials and Methods: This observational cohort study was conducted on 168 patients at Poona Hospital and Research Centre, Pune, India, between June 2018 to November 2019 after obtaining Institutional Ethical Clearance. The patients included were above 18 years of age who had Systolic Blood Pressure (SBP) <90 mmHg, Heart Rate (HR) >100/min and Respiratory Rate (RR) >20/min. The arterial serum lactate level were examined on the day of admission, 12 hours and 24 hours. The need of ionotropic support, duration of ICU stay and mortality in one month was noted. The primary outcome measures were to study the association of on admission arterial serum lactate level with a duration of ICU stay and in-hospital mortality, whereas the secondary outcome measure was to study the association of on admission arterial serum lactate with the requirement of ionotropic support. Analysis of data was done using Statistical Package for Social Sciences for Windows, version 20.0. Results: The incidence in-hospital mortality was 20 (22.7%) out of 88 and 3 (3.8%) out of 80 in patients whose serum lactate levels on admission were >36 mg/dL and ≤36 mg/dL, respectively (p-value=0.002). The median duration of ICU stay was six and three days in patients whose serum lactate levels on admission were >36 mg/dL and ≤36 mg/dL, respectively (p-value=0.001). A 87 (98.9%) patients whose serum lactate levels >36 mg/dL on admission had the higher requirement of inotropes as compared to 35 (50.7%) patients whose serum lactate levels were ≤36 mg/dL. The percentage of patients whose serum lactate level >36 mg/dL, had a significantly higher Quick Sequential Organ Failure Assessment (qSOFA) scores and higher Shock Index (SI). There was a statistically significant positive correlation between serum lactate levels and qSOFA score (r=0.555) and SI (r=0.559). Conclusion: Initial serum lactate level was associated with higher in-hospital mortality, the higher requirement of inotropic support and longer duration of ICU stay.

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Multidrug-resistant Acinetobacter baumannii infections in COVID-19 patients hospitalized in intensive care unit

Infection ◽

10.1007/s15010-021-01643-4 ◽

2021 ◽

Author(s):

Alessandro Russo ◽

Francesca Gavaruzzi ◽

Giancarlo Ceccarelli ◽

Cristian Borrazzo ◽

Alessandra Oliva ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Acinetobacter Baumannii ◽

Steroid Therapy ◽

Multidrug Resistant ◽

Serum Lactate ◽

Cox Regression Analysis ◽

Lactate Levels ◽

The Impact

Abstract Objectives Superinfections in patients hospitalized in intensive care unit (ICU) are an important and challenging complication, also in COVID-19. However, no definitive data are available about the role of multidrug-resistant Acinetobacter baumannii (MDR-AB) in COVID-19. Methods This was a single-center, cross-sectional study including patients with MDR-AB infections admitted to ICU with or without COVID-19, between January 2019 and January 2021. The primary objective of the study was to evaluate risk factor for MDR-AB infections in ICU patients hospitalized for COVID-19 or other etiology. The secondary endpoints were 30-days mortality in all study population and risk factors associated with development of bloodstream infection (BSI). Results During the study period 32 adults with COVID-19 were enrolled and compared with 115 patients admitted in the same ICU for other reasons. We observed a total of 114 deaths, with a survival rate of 29.3%: 18.8% in COVID-19 and 32.2% in control group. Relative risk for MDR-AB infection in COVID-19 showed that serum lactate levels mmol/l > 2, Acinetobacter baumannii colonization, BSI and steroid therapy were observed more frequently in COVID-19 patients. Cox regression analysis showed that serum lactate levels > 2 mmol/l, Acinetobacter baumannii colonization, BSI, and steroid therapy were associated with 30-days mortality. Finally, patients with COVID-19, white blood cells count > 11,000 mm3, serum lactate levels > 2 mmol/l, infections at time of ICU admission, Acinetobacter baumannii colonization, and steroid therapy were independently associated with development of BSI. Conclusions Our data highlight the impact of BSI on outcome, the role of Acinetobacter baumannii colonization and the use of steroids on the risk to develop MDR-AB infections also during COVID-19.

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Analysis of serum lactate levels to predict in hospital mortality in critically ill children admitted to pediatric intensive care unit

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20194730 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2538

Author(s):

Trilok Rao Srigiri ◽

Partha Saradhi Manyam ◽

Uma Mahesh ◽

Gangadhar Belavadi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Blood Lactate ◽

Critically Ill ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Lactate Levels ◽

Blood Lactate Levels ◽

High Lactate

Background: The predictive significance of lactate measurement at admission for mortality in critically ill children remains uncertain. Authors objectives was to study evaluated the predictive value of blood lactate levels at admission and determined the cut-off values for predicting in-hospital mortality in the critically ill pediatric population.Methods: A prospective observational study was done in 100 critically ill admissions to the pediatric intensive care unit (PICU), requiring hemodynamic/respiratory support. The chi-square test for categorical variables performs the comparison.Results: Out of 100 patients, 22 (22%) expired. Mortality is highest in 10-16 age (7%). In the non-survivor group, the majority of patients were diagnosed as pneumonia (7.5%). Median lactate levels in non-survivors are 4.5 at admission when compared to 2.0 in survivors (p<0.001). The mortality rates left rate in the high lactate group (73%) is more when compared to intermediate (20%) and low-level groups (7%). Blood lactate was 75% sensitive and 90% specific at the optimal cut-off value of 33.7 mg/dl. The positive likelihood ratio of predicting death is more with a high lactate level (7.5) when compared to intermediate (0.8) and low levels (0.08). Sensitivity and Specificity with elevated lactate levels is the mortality 24 hrs (89%, 92%) than at admission (75%, 90%). The AUROC values with the admission lactate level are 0.86, and after 24 hrs are 0.95.Conclusions: Blood lactate levels at admission predict mortality in critically ill children requiring hemodynamic/respiratory support.

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Metabolic acidosis in medical intensive care unit with indicators and their prognostic value- A prospective observational study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v8i3.16500 ◽

2017 ◽

Vol 8 (3) ◽

pp. 60-67

Author(s):

Prem Amalraj ◽

Arun Kumar Narayanan ◽

Satish Balan ◽

Mathew Thomas

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Metabolic Acidosis ◽

Traditional Method ◽

Traditional Approach ◽

Serum Lactate ◽

Anion Gap ◽

Apache Ii Score ◽

Acid Base ◽

Lactate Levels

Background: Metabolic acidosis is a common abnormality in the intensive care unit. There has recently been a surge of interest in nontraditional approaches to the analysis of acid base disorders.Aims and Objectives: This study was undertaken to compare the application of the physicochemical method of Stewart and the traditional Henderson-Hasselbach equation withcorrection for albumin in quantification of acid base disorders.Materials and Methods: All patients with metabolic acidosis admitted to the ICU as defined by a base deficit of >2.5 were included in the study. The APACHE II score was calculated at admission and the predicted mortality was defined. The acid base disorders were quantified by the traditional approach with anion gap correction for serum albumin as well as by the Stewart method with calculation of the strong anion gap acidosis.Results: One-hundred forty patients were included in the study of which 58% were males. In 125 subjects (89%) acidosis was discovered by the Stewart method. The traditional method detected increased anion gap in 109 subjects (78%) but this increased to 124 (88.5%) when corrected for albumin. Both the strong ion gap (SIG) and the albumin corrected anion gap correlated strongly. Serum lactate levels and SIG predicted mortality as did albumin corrected anion gap.Conclusion: Albumin correction of the anion gap correlates well with acidosis as discovered by the SIG and therefore should be used in the ICUs rather than the traditional anion gap. With this modification, we can thus depend on the application of the intuitive traditional method rather than the more difficult to apply Stewart method for analysis of the acid base abnormalities in the ICU.Asian Journal of Medical Sciences Vol.8(3) 2017 60-67

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Abstract 417: The Prognostic Value of Lactate in Cardiac Intensive Care Unit Patients With and Without Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.417 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Barry Burstein ◽

Saraschandra Vallabhajosyula ◽

Bradley Ternus ◽

Kianoush Kashani ◽

Gregory W Barsness ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Hospital Mortality ◽

Prognostic Value ◽

Tertiary Care ◽

Multivariable Analysis ◽

Cardiac Intensive Care Unit ◽

Cardiac Intensive Care ◽

Lactate Levels

Introduction: Lactate is a known prognostic marker in critically ill patients, including patients with shock and cardiac arrest (CA). We sought to describe the association between admission lactate and hospital mortality in cardiac intensive care unit (CICU) patients, particularly those with CA. Methods: We retrospectively evaluated adult patients admitted to a tertiary care CICU from January 1, 2007, to April 30, 2018, with measured lactate on admission. We examined hospital mortality as a function of admission lactate level in patients with and without CA. Multivariable logistic regression was used to determine predictors of hospital mortality in the overall cohort, after adjustment for clinical characteristics, therapies, and illness severity. Results: We included 3,042 patients with a median age of 70 years (IQR 60-80), including 40.5% (n=1,233) females. There were 789 patients (26.1%) with a diagnosis of CA. The median APACHE-4 predicted mortality was 24.2% (IQR 10.9-50.7), and 50.8% (n=1546) were treated with vasoactive infusions. The median lactate on admission was 1.8 mmol/L (IQR 1.1-3.0). CICU mortality occurred in 478 (15.7%) patients) and hospital mortality occurred in 706 (23.2%) patients. Hospital mortality rose progressively as a function of admission lactate ( Figure ). On univariable analysis, lactate was associated with increased hospital mortality among the overall cohort (OR 1.36, CI 1.31-1.42, P < .001; AUROC 0.71), patients with CA (OR 1.33 (95% CI 1.25-1.41, P < .01; AUROC 0.73), and patients without CA (OR 1.27, CI 1.21-1.34, P < .01; AUROC 0.64). On multivariable analysis, lactate was one of the most significant predictors of hospital mortality (adjusted OR 1.13 per mmol/L, 95% CI 1.08-1.18, P < .001). Conclusions: Admission lactate levels are strongly associated with increased hospital mortality among CICU patients, especially those with CA. The prognostic value of lactate levels may help inform clinicians caring for CICU patients.

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The sensitivity of qSOFA calculated at triage and during emergency department treatment to rapidly identify sepsis patients

Scientific Reports ◽

10.1038/s41598-020-77438-8 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Sarah M. Perman ◽

Mark E. Mikkelsen ◽

Munish Goyal ◽

Adit Ginde ◽

Abhishek Bhardwaj ◽

...

Keyword(s):

Emergency Department ◽

Hospital Mortality ◽

Serum Lactate ◽

Risk Category ◽

Suspected Infection ◽

Increased Risk ◽

Screening And Identification ◽

Lactate Levels ◽

Poor Outcomes ◽

Sirs Criteria

AbstractThe quick sequential organ failure assessment (qSOFA) score has been proposed as a means to rapidly identify adult patients with suspected infection, in pre-hospital, Emergency Department (ED), or general hospital ward locations, who are in a high-risk category with increased likelihood of “poor outcomes:” a greater than 10% chance of dying or an increased likelihood of spending 3 or more days in the ICU. This score is intended to replace the use of systemic inflammatory response syndrome (SIRS) criteria as a screening tool; however, its role in ED screening and identification has yet to be fully elucidated. In this retrospective observational study, we explored the performance of triage qSOFA (tqSOFA), maximum qSOFA, and first initial serum lactate (> 3 mmol/L) at predicting in-hospital mortality and compared these results to those for the initial SIRS criteria obtained in triage. A total of 2859 sepsis cases were included and the in-hospital mortality rate was 14.4%. The sensitivity of tqSOFA ≥ 2 and maximum qSOFA ≥ 2 to predict in-hospital mortality were 33% and 69%, respectively. For comparison, the triage SIRS criteria and the initial lactate > 3 mmol/L had sensitivities of 82% and 65%, respectively. These results demonstrate that in a large ED sepsis database the earliest measurement of end organ impairment, tqSOFA, performed poorly at identifying patients at increased risk of mortality and maximum qSOFA did not significantly outperform initial serum lactate levels.

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