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.

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 Early lactate measurement is associated with better outcomes in septic patients with an elevated serum lactate level

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Hui Chen ◽  
Chenyan Zhao ◽  
Yao Wei ◽  
Jun Jin
Keyword(s):  
Intensive Care ◽  
Lactate Level ◽  
Medical Information ◽  
Elevated Serum ◽  
Mediation Effect ◽  
Optimal Timing ◽  
Icu Admission ◽  
Lactate Measurement ◽  
Significant Difference ◽  
Lactate Levels

Abstract Background The optimal timing of lactate measurement for septic patients in the intensive care unit (ICU) remains controversial, and whether initiating and repeating the lactate measurement earlier could make a difference for septic patients with an elevated lactate level remains unexplored. Methods This was a retrospective observational study that included septic patients with an initial lactate level > 2.0 mmol/L after ICU admission, and all data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The main exposure of interest was the early lactate measurement, which was defined as an initial lactate level measurement within 1 h after ICU admission. The primary outcome was 28-day mortality. Results A total of 2642 eligible subjects were enrolled, including 738 patients who had initial lactate measurements completed within 1 h (EL group) and 1904 patients who had initial lactate measurements completed more than 1 h after ICU admission (LL group). A significant beneficial effect of early lactate measurement in terms of 28-day mortality was observed: the adjusted odds ratio (OR) was 0.69 (95% CI 0.55–0.87; p = 0.001), and the mediation effect of the time to initial vasopressor administration was significant (average causal mediation effect (ACME) − 0.018; 95% CI − 0.005 approximately to − 0.036; p < 0.001). A strong relationship between delayed initial lactate measurement and risk-adjusted 28-day mortality was noted (OR 1.04; 95% CI 1.02–1.05; p < 0.001). Each hour of delay in remeasuring the lactate level was associated with an increase in 28-day mortality in the EL group (OR 1.09; 95% CI 1.04–1.15; p < 0.001). Further analysis demonstrated that repeating the measurement 3 h after the initial lactate measurement led to a significant difference. Conclusions Early lactate measurement is associated with a lower risk-adjusted 28-day mortality rate in septic patients with lactate levels > 2.0 mmol/L. A shorter time to the initial vasopressor administration may contribute to this relationship. Repeating the lactate measurement within 3 h after the initial measurement is appropriate for patients whose lactate levels were measured within 1 h of admission.

scholarly journals Association Between Oxygen Partial Pressure Trajectories and Short-Term Outcomes in Patients With Hemorrhagic Brain Injury

2021 ◽  
Vol 8 ◽  
Author(s):  
Guolong Cai ◽  
Weizhe Ru ◽  
Qianghong Xu ◽  
Jiong Wu ◽  
Shijin Gong ◽  
...  
Keyword(s):  
Intensive Care ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Oxygen Partial Pressure ◽  
Partial Pressure ◽  
Medical Information ◽  
Logistic Models ◽  
Neurological Outcomes ◽  
Risk Of Death ◽  
Logistic Analysis

Objectives: Arterial hyperoxia is reportedly a risk factor for poor outcomes in patients with hemorrhagic brain injury (HBI). However, most previous studies have only evaluated the effects of hyperoxia using static oxygen partial pressure (PaO2) values. This study aimed to investigate the association between overall dynamic oxygenation status and HBI outcomes, using longitudinal PaO2 data.Methods: Data were extracted from the Medical Information Mart for Intensive Care III database. Longitudinal PaO2 data obtained within 72 h of admission to an intensive care unit were analyzed, using a group-based trajectory approach. In-hospital mortality was used as the primary outcomes. Multivariable logistic models were used to explore the association between PaO2 trajectory and outcomes.Results: Data of 2,028 patients with HBI were analyzed. Three PaO2 trajectory types were identified: Traj-1 (mild hyperoxia), Traj-2 (transient severe hyperoxia), and Traj-3 (persistent severe hyperoxia). The initial and maximum PaO2 of patients with Traj-2 and Traj-3 were similar and significantly higher than those of patients with Traj-1. However, PaO2 in patients with Traj-2 decreased more rapidly than in patients with Traj-3. The crude in-hospital mortality was the lowest for patients with Traj-1 and highest for patients with Traj-3 (365/1,303, 209/640, and 43/85 for Traj-1, Traj-2, and Traj-3, respectively; p &lt; 0.001), and the mean Glasgow Coma Scale score at discharge (GCSdis) was highest for patients with Traj-1 and lowest in patients with Traj-3 (13 [7–15], 11 [6–15], and 7 [3–14] for Traj-1, Traj-2, and Traj-3, respectively; p &lt; 0.001). The multivariable model revealed that the risk of death was higher in patients with Traj-3 than in patients with Traj-1 (odds ratio [OR]: 3.3, 95% confidence interval [CI]: 1.9–5.8) but similar for patients with Traj-1 and Traj-2. Similarly, the logistic analysis indicated the worst neurological outcomes in patients with Traj-3 (OR: 3.6, 95% CI: 2.0–6.4, relative to Traj-1), but similar neurological outcomes for patients in Traj-1 and Traj-2.Conclusion: Persistent, but not transient severe arterial hyperoxia, was associated with poor outcome in patients with HBI.

scholarly journals Plasma lactate levels and lactate clearance as predictors of outcome in patients with sepsis and septic shock

2020 ◽  
Vol 7 (6) ◽  
pp. 1213
Author(s):  
Rashmi Patil ◽  
Chikkanarasareddy P. S. ◽  
Mallesh K.
Keyword(s):  
Septic Shock ◽  
Clinical Decision Making ◽  
Early Recognition ◽  
Early Stage ◽  
Therapeutic Option ◽  
Lactate Clearance ◽  
Plasma Lactate ◽  
Risk Of Death ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

Background: Severe sepsis and septic shock are the major causes of admission and deaths in the ICU, killing one in four (and often more) and increasing in incidence. In order to improve the clinical outcomes in these patients, it is crucial to obtain early recognition of patients who are at risk of death and to optimize the clinical decision making in a timely manner. In order to monitor the metabolic consequences of shock and hemodynamic management, plasma lactate levels can be used in critical illness. Objective of the study is to estimate plasma lactate and lactate clearance in sepsis and septic shock patients and to correlate plasma lactate and lactate clearance as predictors of mortality.Methods: This study is a prospective observational study conducted over 18months. Children with age of 1 month to 18 years admitted to the Paediatric intensive care unit with sepsis and septic shock were enrolled in the study. ABG at admission to document plasma lactate and lactate repeated at 6 and 24 hrs. Lactate clearance calculated at 6 and 24 hrs. The final outcome in terms of survival or death will be recorded.Results: Majority of the children fall in the class between 1-6 months 51(48.11%). Male comprises 69(65.09%). Among these, Sepsis 36(33.96%); followed by Pneumonia 34(32.07%). Survivors group were 35(33.02%) and non-survivor was 71(66.98%). The Non survivor group was observed to have lower mean values of lactate clearance and found to be statistically significant. Specificity of Lactate clearance was 63.52% and Sensitivity 76.02% respectively. The results were positively associated with lactate level at 24 hours found to be significant effect of survivability when compared to non-survivor.Conclusions: Lactate clearance is vital and markable sign for screening of septic shock at early stage for therapeutic option. Further, 24-hours lactate estimation (cut off values) clearance appears superior to 6 h lactate clearance in predicting mortality in such patients.

scholarly journals Association of Plasma Lactate Level With 28-day Mortality in Non-elderly and Elderly Sepsis Patients: A Retrospective Cohort Study Based on the Mimic-III Database

2020 ◽  
Author(s):  
Yihua Dong ◽  
Xiaoyang Miao ◽  
Yufeng Hu ◽  
Yueyue Huang ◽  
Jie Chen ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Intensive Care ◽  
Lactate Level ◽  
Medical Information ◽  
Binary Logistic Regression ◽  
The Elderly ◽  
Continuous Variable ◽  
Elderly Group ◽  
Logistic Regression Models ◽  
The Relationship

Abstract Purpose: The objective of this study is to assess the clinical usefulness of lactate as a predictor of 28-day mortality and the relationship between lactate and 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. Prognosis was evaluated using receiver operating characteristic (ROC) analysis. Univariate and multivariable binary logistic regression models were used to identify the association lactate with 28-day mortality. We converted continuous variable lactate into a categorical variable based on tri-segment quantile to explore segmentation effects.Results: The average age of 2848 patients was 68.01 years old, and about 55.40% of them were male. The overall 28-day mortality was 30.41%, and the rate in elderly patients was 65.82%. Among non-survivors, the lactate level was significantly greater for the non-elderly than the elderly. Lactate level was positively associated with risk of 28-day mortality of the non-elderly sepsis patients (p for trend < 0.001), but there was no significant association between lactate level and 28-day mortality in the elderly group (p for trend = 0.830). The association between lactate and 28-day mortality for sepsis patients without liver cirrhosis was stronger than for sepsis patients with liver cirrhosis (OR 1.28 vs. OR 1.10, P =0.027).Conclusion: Increased lactate level is associated with higher 28-day mortality in the non-elderly sepsis patients, but there is no significant association between the lactate level and 28-day mortality in the elderly group.

Prognosis of Very Elderly Patients After Intensive Care

2021 ◽  
Author(s):  
Philippe Michel ◽  
Fouad FADEL ◽  
Gaëtan Plantefève ◽  
Stephan Ehrmann ◽  
bruno Gelée
Keyword(s):  
Intensive Care ◽  
Elderly Patients ◽  
Telephone Interview ◽  
Epidemiological Data ◽  
Acute Pulmonary Oedema ◽  
Age Group ◽  
Very Elderly ◽  
Exclusion Criteria ◽  
Saps Ii ◽  
Saps Ii Score

Abstract Background: Very elderly patients (aged over 85 years) are increasingly treated in intensive care units (ICU) despite the reluctance of doctors to admit these patients considered fragile. Only a few studies in this age group have described the relevance of treatment of these patients in the intensive care unit. Methods: he inclusion criterion for this study was patients aged 85 years or over on admission. The exclusion criteria were high dependence before admission or an inability to answer the telephone. Epidemiological data, antecedents, lifestyle, autonomy (ADL score of six items) were recorded on admission to the ICU and by telephone interview at six months. Results: Eight French ICU included 239 patients aged over 85 years. The most common diagnoses were non-cradiogenic lung disease (36%), severe sepsis / septic shock (29%) and acute pulmonary oedema (28%). 23% of patients were dependent on admission. 71% of patients were still living when discharged from the ICU and 52% were still living at 6 months. Among the non-dependent patients before hospitalisation, 17% became dependent. The only prognostic criteria found were the SAPS II score on admission and the place of residence before admission (nursing home or ”with family” had a poor prognosis). Conclusions: Although the prognosis of these very elderly patients was good after hospitalisation in the ICU, it should be noted that the population was highly selected with few comorbidities or dependence. No triage criteria could be proposed. ClinicalTrials.gov Identifier: NCT02849756

scholarly journals Age-stratified perioperative mortality after urological surgeries

2018 ◽  
Vol 12 (8) ◽  
Author(s):  
Brendan Wallace ◽  
Rodney H. Breau ◽  
Sonya Cnossen ◽  
Christopher Knee ◽  
Daniel McIsaac ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Patient Selection ◽  
Surgical Approach ◽  
Absolute Risk ◽  
Secondary Outcome ◽  
Age Group ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Urological Procedures ◽  
The Absolute

Introduction: More elderly patients are presenting for surgical consultation. Understanding the risk of mortality by age group after urological surgery is important for patient selection and counselling.Methods: A historical cohort study of The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006–2015 was performed. Current procedural terminology (CPT) codes for similar surgical procedures were grouped for analyses. Urological procedures commonly performed in elderly patients were identified and stratified by patient age and surgical approach (open vs. laparoscopic/robotic). The primary outcome was the absolute risk of death by 30 days stratified by age for each surgical procedure. The secondary outcome was risk of death by surgical approach (open vs. laparoscopic/robotic).Results: Twelve urological procedures were reviewed including 124 262 patients. A total of 1011 (0.8%) deaths occurred by 30 days after surgery. The procedure with the highest incidence of mortality by 30 days was open nephroureterectomy (2.9 %). In patients 80 years and over, the procedure with the highest incidence of death was open radical nephrectomy (5.32%). There was an increased risk of mortality with increasing age group for all procedures. Unadjusted risk of mortality was consistently higher in patients who receive open compared to laparoscopic surgery.Conclusions: There is an increasing risk of mortality with age and with open surgical approach in urology. Knowledge regarding the absolute risk of mortality in patients receiving common urological surgeries may improve patient selection and counselling.

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