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Prognostic relevance of serum lactate kinetics in critically ill patients

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Abstract

Purpose

Changes of lactate concentration over time were reported to be associated with survival in septic patients. We aimed to evaluate delta-lactate (ΔLac) 24 h after admission (Δ24Lac) to an intensive care unit (ICU) in critically ill patients for short- and long-term prognostic relevance.

Methods

In total, 26,285 lactate measurements of 2191 patients admitted to a German ICU were analyzed. Inclusion criterion was a lactate concentration at admission above 2.0 mmol/L. Maximum lactate concentrations of day 1 and day 2 were used to calculate Δ24Lac. Follow-up of patients was performed retrospectively. Association of Δ24Lac and both in-hospital and long-term mortality were investigated. An optimal cut-off was calculated by means of the Youden index.

Results

Patients with lower Δ24Lac were of similar age, but clinically sicker. As continuous variable, higher Δ24Lac was associated with decreased in-hospital mortality (per 1% Δ24Lac; HR 0.987 95%CI 0.985–0.990; p < 0.001) and an optimal Δ24Lac cut-off was calculated at 19%. Δ24Lac ≤ 19% was associated with both increased in-hospital (15% vs 43%; OR 4.11; 95%CI 3.23–5.21; p < 0.001) and long-term mortality (HR 1.54 95%CI 1.28–1.87; p < 0.001), even after correction for APACHE II, need for catecholamines and intubation. We matched 256 patients with Δ24Lac ≤ 19% to case–controls > 19% corrected for APACHE II scores, baseline lactate level and sex: Δ24Lac ≤ 19% remained associated with lower in-hospital and long-term survival.

Conclusions

Lower Δ24Lac was robustly associated with adverse outcome in critically ill patients, even after correction for confounders. Δ24Lac might constitute an independent, easily available and important parameter for risk stratification in the critically ill.

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Acknowledgements

We would like to thank Katharina Bannier and Julian Gonschorrek for their support in collecting the patients’ follow-up. MM was supported by a GEROK scholarship by the Collaborative Research Center 1116 (DFG).

Author information

Author notes

  1. Maryna Masyuk and Bernhard Wernly contributed equally.

  2. Jan Bakker and Christian Jung contributed equally.

Authors and Affiliations

  1. Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany

    Maryna Masyuk, Johanna M. Muessig, Malte Kelm & Christian Jung

  2. CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany

    Maryna Masyuk, Johanna M. Muessig, Malte Kelm & Christian Jung

  3. Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria

    Bernhard Wernly, Michael Lichtenauer & Uta C. Hoppe

  4. Department of Cardiology, Clinic of Internal Medicine I, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany

    Marcus Franz, Bjoern Kabisch & P. Christian Schulze

  5. Department of Neurology, Christian Doppler Clinic and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria

    Georg Zimmermann

  6. Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria

    Georg Zimmermann

  7. Department of Mathematics, Paris Lodron University, Salzburg, Austria

    Georg Zimmermann

  8. Department of Cardiology, Charité, University Hospital Berlin, Hindenburgdamm 30, 12203, Berlin, Germany

    Alexander Lauten

  9. German Center for Cardiovascular Research (DZHK), University Heart Center, Charitéplatz 1, 10117, Berlin, Germany

    Alexander Lauten

  10. Department of Intensive Care Adults, Erasmus MC University Medical Center, 3000 CA, Rotterdam, The Netherlands

    Jan Bakker

  11. Department of Pulmonology and Critical Care, New York University Medical Center, New York, 10022, NY, USA

    Jan Bakker

  12. Department of Pulmonology and Critical Care, Columbia University Medical Center, NY, 10032, NY, USA

    Jan Bakker

  13. Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile

    Jan Bakker

Authors
  1. Maryna Masyuk
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  2. Bernhard Wernly
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  7. Georg Zimmermann
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  8. Alexander Lauten
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  13. Christian Jung
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Contributions

MM and BW analyzed and interpreted the data, drafted the submitted manuscript and approved the final version to be published. MF, BK, CJ and PCS substantially contributed to acquisition and interpretation of data, revised the manuscript critically and approved the final version to be published. ML, JMM, AL, UCH and MK substantially contributed to interpretation of data, revised the manuscript critically for important intellectual content and approved the final version to be published. GZ gave statistical advice. JB and CJ substantially contributed to conception and design and to the interpretation of data, revised the manuscript critically for important intellectual content and approved the final version to be published.

Corresponding author

Correspondence to Christian Jung.

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The authors declare that they have no conflict of interest.

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The study has been approved by the local ethics committee of the Jena University Hospital.

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Masyuk, M., Wernly, B., Lichtenauer, M. et al. Prognostic relevance of serum lactate kinetics in critically ill patients. Intensive Care Med 45, 55–61 (2019). https://doi.org/10.1007/s00134-018-5475-3

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