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Adding lactate to SOFA and qSOFA scores predicts in-hospital mortality better in older patients in critical care

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Key Summary Points

AbstractSection Aim

To determine adding lactate to SOFA and qSOFA score improves the performance of the predicting mortailty of older patients.

AbstractSection Findings

Cut-off value for lactate was 2.3 mmol/L in our ROC analyses. The lactate 2.3 mmol/L threshold-based SOFA-Lactate2.3 and qSOFA-Lactate2.3 scores performs better than standard SOFA and qSOFA identifying hospital mortality risks of patients over 65 who are admitted to the ICU.

AbstractSection Message

Lactate value in olders critically ill patients may predict mortality alone and with other scores.

Abstract

Aim

The aim of this study was to determine whether the addition of the lactate level to the SOFA score (SOFA-Laktat) and qSOFA Score (qSOFA-Laktat) improves the performance of the SOFA score and qSOFA score alone in predicting the hospital mortality of critically ill older patients.

Material and method

A total of 799 patients over 65 years of age admitted to Emergency Department and hospitalized to intensive care unit (ICU) of our hospital between May 1, 2016, and April 30, 2017, were included in this study. The parameters gender, age, initial complaint, duration of time between the start of their complaint and emergency admission, comorbidities, SOFA scores, qSOFA scores, arterial lactate (AL) values and reason for acute admission, which intensive care unit admitted to, length of stay and patients outcomes (discharge, exitus) were recorded. The primary outcome was to evaluate whether the addition of the evaluation of AL value increased the performance of the SOFA score and qSOFA score in predicting hospital mortality.

Results

Data of 799 patients were analyzed, in which 52.8% (n = 422) were male and 47.3% (n = 377) were female. Most frequently hospitalized clinic was coronary ICU (34.7%, n = 277). Mean duration of hospitalization was 5.2 ± 8.7 days. Hospitalization was prolonged with increased lactate, SOFA and qSOFA levels. Cutoff value for lactate was 2.3 mmol/L in our ROC analyses. Predictive value of SOFA-Lactate2.3 for mortality was significantly higher than SOFA score (p < 0.001). Also, predictive value of qSOFA-Lactate2.3 for mortality was significantly higher than qSOFA score (p < 0.001).

Conclusion

The lactate 2.3 mmol/L threshold-based SOFA-Lactate2.3 and qSOFA-Lactate2.3 scores perform better than SOFA and qSOFA alone in identifying hospital mortality risks of patients over 65 who are admitted to the ICU.

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Authors and Affiliations

  1. Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey

    Arif Aksu, Muge Gulen, Akkan Avci & Salim Satar

Authors
  1. Arif Aksu
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  2. Muge Gulen
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  3. Akkan Avci
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  4. Salim Satar
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Corresponding author

Correspondence to Muge Gulen.

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The authors have no conflicts of interests to declare.

Ethical approval

This study started after obtaining ethics approval from the T.C. The Ministiry of Health, Health Sciences University Adana Numune Training and Research Hospital Scientific Research Evaluation Commission.

Informed consent

The patients were included in the study after taken informed consent from the patients’ relatives if not possible to take it from the patients.

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Aksu, A., Gulen, M., Avci, A. et al. Adding lactate to SOFA and qSOFA scores predicts in-hospital mortality better in older patients in critical care. Eur Geriatr Med 10, 445–453 (2019). https://doi.org/10.1007/s41999-019-00179-z

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  • DOI: https://doi.org/10.1007/s41999-019-00179-z

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