Dynamic lactate indices as predictors of outcome in critically ill patients

Nichol, Alistair, Bailey, Michael, Egi, Moritoki, Pettila, Ville, French, Craig, Stachowski, Edward, Reade, Michael C., Cooper, David James and Bellomo, Rinaldo (2011) Dynamic lactate indices as predictors of outcome in critically ill patients. Critical Care, 15 . doi:10.1186/cc10497


Author Nichol, Alistair
Bailey, Michael
Egi, Moritoki
Pettila, Ville
French, Craig
Stachowski, Edward
Reade, Michael C.
Cooper, David James
Bellomo, Rinaldo
Title Dynamic lactate indices as predictors of outcome in critically ill patients
Journal name Critical Care   Check publisher's open access policy
ISSN 1364-8535
1466-609X
Publication date 2011-10-20
Year available 2011
Sub-type Article (original research)
DOI 10.1186/cc10497
Open Access Status DOI
Volume 15
Total pages 10
Place of publication Philadelphia, PA, United States
Publisher Current Science
Language eng
Formatted 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: This was a 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 (LACΔ24) 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 LACΔ24 the risk of hospital death increased by 37% (OR 1.37, 1.29 to 1.45; P < 0.0001) and by 15% (OR 1.15, 1.10 to 1.20; P < 0.0001) respectively. Such dynamic indices, when combined with Acute Physiology and Chronic Health Evaluation II (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 LACΔ24 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.
Keyword Critical illness
Dynamic
Hyperlactaemia
Intensive care unit
Lactate
Mortality
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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