Dataset Information

Lactate clearance as a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review study protocol.

ABSTRACT:

Introduction

Arterial lactate is a reflection of balance between lactate production and clearance. Accumulating lactate may be a marker of global hypoxia or hypoperfusion. Lactate clearance is the reduction of lactate concentrations with interventional strategies, and it has been associated with increased risk of death in critically ill patients. However, conflicting results exist, which mandates a systematic review to clarify the association between lactate clearance and clinical outcome.

Methods and analysis

Critically ill adult patients will be included in our analysis. This population will include heterogeneous study participants, including patients with sepsis or severe sepsis, trauma, surgical intensive care unit (ICU) patients, and so on. We will search four databases including EBSCO, PubMed, Scopus and ISI Web of knowledge from inception to February 2014. There will be no language restrictions in the electronic search for studies. Newcastle Ottawa Scale for cohort study will be employed to assess the reporting quality of included original studies. We will report pooled relative risk of death for those with lactate clearance and those without. The diagnostic performance of lactate clearance in predicting mortality will be explored by using the hierarchical summary receiver operating characteristic model.

Ethics and dissemination

The protocol for the systematic review has been registered in PROSPERO. The study will be disseminated electronically and in print. It will also be presented to conferences related to critical care medicine.

Trial registration number

CRD42013006511.

SUBMITTER: Zhang Z

PROVIDER: S-EPMC4039865 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Lactate clearance as a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review study protocol.

Zhang Zhongheng Z Xu Xiao X Chen Kun K

BMJ open 20140523 5

<h4>Introduction</h4>Arterial lactate is a reflection of balance between lactate production and clearance. Accumulating lactate may be a marker of global hypoxia or hypoperfusion. Lactate clearance is the reduction of lactate concentrations with interventional strategies, and it has been associated with increased risk of death in critically ill patients. However, conflicting results exist, which mandates a systematic review to clarify the association between lactate clearance and clinical outcom ...[more]

PMID: 24860001

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Project description:We investigated the added predictive value of lactate and lactate clearance to the Acute Physiology and Chronic Health Evaluation IV model for predicting in-hospital mortality in critically ill patients with sepsis.DesignRetrospective observational cohort study.SettingMixed ICU of Leiden University Medical Center, The Netherlands.PatientsCritically ill patients adult patients with sepsis who have been admitted to the ICU of Leiden University Medical Center, The Netherlands, from 2006 to January 2018.InterventionsNone.Measurements and main resultsWe fitted a baseline model with the Acute Physiology and Chronic Health Evaluation IV predictors and added 13 prespecified combinations of lactate and lactate clearance at 0, 6 and 24 hours after admission to create a set of extended models to compare with the baseline Acute Physiology and Chronic Health Evaluation IV model. Among 603 ICU admissions, 451 patients met the inclusion criteria. A total of 160 patients died in-hospital, of which 106 died in the ICU. Their lactate and lactate clearance measurements were higher at all time points than those of survivors. The Akaike Information Criterion score improved in 10 of 13 prespecified extended models, with best performance for models that included lactate at 24 hours, alone or in combination with lactate at admission or lactate clearance at 24 hours. We compared the observed and predicted probabilities of in-hospital mortality of the baseline Acute Physiology and Chronic Health Evaluation IV model with the best model in our data, lactate at 24 hours added to the Acute Physiology and Chronic Health Evaluation IV model. This resulted in an increase in specificity of 29.9% (95% CI, 18.9-40.9%).ConclusionsLactate measurements at 24 hours after admission add predictive value to the prediction of mortality with Acute Physiology and Chronic Health Evaluation IV among ICU patients with sepsis. External validation is needed to develop extended prediction models.

Project description:Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide. Early identification of high-risk patients is crucial for timely interventions and improved outcomes. The lactate/albumin ratio (LAR) has been suggest as a significant correlate for assessing the risk of mortality in critically ill patients. This study aimed to utilize the American eICU Collaborative Research Database to explore the association between baseline LAR and all-cause mortality within 28 days in ICU of critically ill patients diagnosed with AMI. We conducted a retrospective cohort study of 989 AMI patients from the eICU Collaborative Research Database. Patients were included based on ICD-9 code 410 and the universal definition of AMI. LAR was calculated as the ratio of baseline lactate to albumin levels within the first 24 h of ICU admission. The outcome was all-cause mortality within 28 days after ICU admission. Multivariable logistic regression models were used to evaluate the independent association between LAR and the risk of death, adjusting for potential confounders including demographics, comorbidities, vital signs, and laboratory parameters. Subgroup analyses and nonlinear modeling were performed to further explore the relationship. Of the 989 AMI patients, 171 (17.3%) died within 28 days after ICU admission. Patients who died had significantly higher LAR compared to survivors (1.66 vs. 0.96, p < 0.001). Multivariable analysis showed that each unit increase in LAR was associated with a 2.15-fold higher risk of all-cause mortality within 28 days after ICU admission (95% CI: 1.64-2.83, p < 0.001). Subgroup analyses confirmed the consistent association across different patient characteristics. Nonlinear modeling revealed a threshold effect, where LAR above 2.15 was no longer significantly associated with mortality. Kaplan-Meier survival analysis demonstrated lower survival probabilities for patients with higher LAR(1.0526-5.8235). The findings suggest that a higher LAR was associated with an increased risk of 28-day all-cause mortality for critically ill patients with AMI after ICU admission.

Project description:BackgroundTo develop a scoring system related to the lactate clearance (ΔLA) to predict the mortality risk (MELD-ΔLA) for critically ill cirrhotic patients.MethodsIn this retrospective cohort study, 881 critically ill cirrhotic patients from the Medical Information Mart for Intensive Care (MIMIC-III) database were included eventually. The outcomes of our study were defined as ICU death, 28-day, 90-day and 1-year mortality. Predictors were identified by multivariate Cox analysis to develop the predictive scoring system. The C-index and area under the curve (AUC) of receiver operator characteristic curve (ROC) were used to identify the predicting performance of the MELD-ΔLA, sequential organ failure assessment (SOFA), chronic liver failure-sequential organ failure assessment (CLIF-SOFA), the model for end-stage liver disease (MELD), Child-Pugh, chronic liver failure consortium acute-on-chronic liver failure (CLIF-C ACLF), chronic liver failure consortium-acute decompensation (CLIF-C AD) and MELD-Na scoring systems. Additionally, subgroup analysis was also performed based on whether critically ill cirrhotic patients underwent liver transplantation.ResultsCreatinine, bilirubin, international normalized ratio (INR), lactate first, ΔLA and vasopressors were closely associated with ICU death of liver critically ill cirrhotic patients. The C-index of the MELD-ΔLA in ICU death was 0.768 (95% CI 0.736-0.799) and the AUC for the MELD-ΔLA scoring system in predicting 28-day, 90-day, and 1-year mortality were 0.774 (95% CI 0.743-0.804), 0.765 (95% CI 0.735-0.796), and 0.757 (95% CI 0.726-0.788), suggested that MELD-ΔLA scoring system has a good predictive value than SOFA, CLIF-SOFA, MELD, Child-Pugh, CLIF-C ACLF, CLIF-C AD) and MELD-Na scoring systems. Additionally, the study also confirmed the good predictive value of MELD-ΔLA scoring system for critically ill cirrhotic patients regardless of undergoing liver transplantation.ConclusionThe developed MELD-ΔLA score is a simple scoring system in predicting the risk of ICU death, 28-day, 90-day and 1-year mortality for critically ill cirrhotic patients, which may have a good predictive performance.

Project description:BackgroundHyperlactataemia (HL) is a biomarker of disease severity that predicts mortality in patients with sepsis and malaria. Lactate clearance (LC) during resuscitation has been shown to be a prognostic factor of survival in critically ill adults, but little data exist for African children living in malaria-endemic areas.MethodsIn a secondary data analysis of severely ill febrile children included in the Fluid Expansion as Supportive Therapy (FEAST) resuscitation trial, we assessed the association between lactate levels at admission and LC at 8 h with all-cause mortality at 72 h (d72). LC was defined as a relative lactate decline ≥ 40% and/or lactate normalisation (lactate < 2.5 mmol/L).ResultsOf 3170 children in the FEAST trial, including 1719 children (57%) with Plasmodium falciparum malaria, 3008 (95%) had a baseline lactate measurement, 2127 (71%) had HL (lactate ≥ 2.5 mmol/L), and 1179 (39%) had severe HL (≥ 5 mmol/L). Within 72 h, 309 children (10.3%) died, of whom 284 (92%) had baseline HL. After adjustment for potential confounders, severe HL was strongly associated with mortality (Odds Ratio (OR) 6.96; 95% CI 3.52, 13.76, p < 0.001). This association was not modified by malaria status, despite children with malaria having a higher baseline lactate (median 4.6 mmol/L vs 3 mmol/L; p < 0.001) and a lower mortality rate (OR = 0.42; p < 0.001) compared to non-malarial cases. Sensitivity and specificity analysis identified a higher lactate on admission cut-off value predictive of d72 for children with malaria (5.2 mmol/L) than for those with other febrile illnesses (3.4 mmol/L). At 8 h, 2748/3008 survivors (91%) had a lactate measured, 1906 (63%) of whom had HL on admission, of whom 1014 (53%) fulfilled pre-defined LC criteria. After adjustment for confounders, LC independently predicted survival after 8 h (OR 0.24; 95% CI 0.14, 0.42; p < 0.001). Absence of LC (< 10%) at 8 h was strongly associated with death at 72 h (OR 4.62; 95% CI 2.7, 8.0; p < 0.001).ConclusionsIndependently of the underlying diagnosis, HL is a strong risk factor for death at 72 h in children admitted with severe febrile illnesses in Africa. Children able to clear lactate within 8 h had an improved chance of survival. These findings prompt the more widespread use of lactate and LC to identify children with severe disease and monitor response to treatment.Trial registrationISRCTN69856593 Registered 21 January 2009.

Dataset Information

Lactate clearance as a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review study protocol.

Introduction

Methods and analysis

Ethics and dissemination

Trial registration number

Publications

Lactate clearance as a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review study protocol.

Similar Datasets

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