| Prognostic value of blood lactate levels: does the clinical diagnosis at admission matter? | |
| | |
MedLine Citation:
|
PMID: 19204510 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Hyperlactatemia and its reduction after admission in the intensive care unit (ICU) have been related to survival. Because it is unknown whether this equally applies to different groups of critically ill patients, we compared the prognostic value of repeated lactate levels (a) in septic patients versus patients with hemorrhage or other conditions generally associated with low-oxygen transport (LT) (b) in hemodynamically stable versus unstable patients. METHODS: In this prospective observational two-center study (n = 394 patients), blood lactate levels at admission to the ICU (Lac(T0)) and the reduction of lactate levels from T = 0 to T = 12 hours (DeltaLac(T0-12)) and from T = 12 to T = 24 hours (DeltaLac(T12-24)), were related to in-hospital mortality. RESULTS: Reduction of lactate was associated with a lower mortality only in the sepsis group (DeltaLac(T0-12): hazard ratio [HR] 0.34, p = 0.004 and DeltaLac(T12-24): HR 0.24, p = 0.003), but not in the LT group (DeltaLac(T0-12); HR 0.78, p = 0.52 and DeltaLac(T12-24); HR 1.30, p = 0.61). The prognostic values of Lac(T0), DeltaLac(T0-12), and DeltaLac(T12-24) were similar in hemodynamically stable and unstable patients (p = 0.43). CONCLUSIONS: Regardless of the hemodynamic status, lactate reduction during the first 24 hours of ICU stay is associated with improved outcome only in septic patients, but not in patients with hemorrhage or other conditions generally associated with LT. We hypothesize that in this particular group a reduction in lactate is not associated with improved outcome due to irreversible damage at ICU admission. |
| | |
Authors:
|
Tim C Jansen; Jasper van Bommel; Paul G Mulder; Alexandre P Lima; Ben van der Hoven; Johannes H Rommes; Ferdinand T F Snellen; Jan Bakker |
Publication Detail:
|
Type: Journal Article; Multicenter Study |
Journal Detail:
|
Title: The Journal of trauma Volume: 66 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2009 Feb |
Date Detail:
|
Created Date: 2009-02-10 Completed Date: 2009-04-28 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
|
Languages: eng Pagination: 377-85 Citation Subset: AIM; IM |
Affiliation:
|
Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
APACHE Aged Critical Illness* Female Hemodynamics Hospital Mortality Humans Intensive Care Units Lactic Acid / blood* Male Middle Aged Outcome Assessment (Health Care)* Predictive Value of Tests Prognosis Proportional Hazards Models Prospective Studies ROC Curve Sepsis / blood*, mortality* |
| Chemical | |
Reg. No./Substance:
|
50-21-5/Lactic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: HBOC-201 vasoactivity in a phase III clinical trial in orthopedic surgery subjects--extrapolation of...
Next Document: Autonomous control of inspired oxygen concentration during mechanical ventilation of the critically ...