Dynamic Lactate Indices as Predictors of Outcome in Critically Ill Patients.
Crit Care. 2011 Oct 20;15(5):R242
Authors: Nichol A, Bailey M, Egi M, Pettila V, French C, Hart GK, Stachowski E, Reade MC, Cooper DJ, Bellomo R
ABSTRACT: INTRODUCTION: Dynamic changes in lactate concentrations in the critically ill may predict patient outcome more accurately than static indices. We aimed to compare the predictive value of dynamic indices of lactatemia in the first 24 hours of intensive care unit (ICU) admission with the value of more commonly used static indices. METHODS: Retrospective observational study of a prospectively obtained intensive care database of 5,041 consecutive critically ill patients from four Australian university hospitals. We assessed the relationship between dynamic lactate values collected in the first 24 hours of ICU admission and both ICU and hospital mortality. RESULTS: We obtained 36,673 lactate measurements in 5,041 patients in the first 24 hours of ICU admission. Both the time weighted average lactate (LACTW24) and the change in lactate (LACDelta24) over the first 24 hours were independently predictive of hospital mortality with both relationships appearing to be linear in nature. For every one unit increase in LACTW24 and LACDelta24 the risk of hospital death increased by 37% (OR 1.37, 1.29-1.45; p<0.0001) and by 15% (OR 1.15, 1.10-1.20; p<0.0001) respectively. Such dynamic indices, when combined with APACHE II scores, improved overall outcome prediction (P<0.0001) achieving almost 90% accuracy. When all lactate measures in the first 24 hours were considered, the combination of LACTW24 and LACDelta24 significantly outperformed (P<0.0001) static indices of lactate concentration such as admission lactate, maximum lactate and minimum lactate. CONCLUSIONS: In the first 24 hours following ICU admission, dynamic indices of hyperlactatemia have significant independent predictive value, improve the performance of illness severity score-based outcome predictions and are superior to simple static indices of lactate concentration.
PMID: 22014216 [PubMed - as supplied by publisher]