Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: A retrospective observational study
OBJECTIVES:To evaluate whether the level and duration of increased blood lactate levels are associated with daily Sequential Organ Failure Assessment (SOFA) scores and organ subscores and to evaluate these associations during the early and late phases of the intensive care unit stay. DESIGN:Retrospe...
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| Veröffentlicht in: | Critical care medicine 2009-08, Vol.37 (8), p.2369-2374 |
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| creator | Jansen, Tim C van Bommel, Jasper Woodward, Roger Mulder, Paul G. H Bakker, Jan |
| description | OBJECTIVES:To evaluate whether the level and duration of increased blood lactate levels are associated with daily Sequential Organ Failure Assessment (SOFA) scores and organ subscores and to evaluate these associations during the early and late phases of the intensive care unit stay.
DESIGN:Retrospective observational study.
SETTING:Mixed intensive care unit of a university hospital.
PATIENTS:134 heterogeneous intensive care unit patients.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We calculated the area under the lactate curve above 2.0 mmol/L (lactateAUC>2). Daily SOFA scores were collected during the first 28 days of intensive care unit stay to calculate initial (day 1), maximal, total and mean scores. Daily lactateAUC>2 values were related to both daily SOFA scores and organ subscores using mixed-model analysis of variance. This was also done separately during the early (2.75 days) phase of the intensive care unit stay.Compared with normolactatemic patients (n = 78), all median SOFA variables were higher in patients with hyperlactatemia (n = 56) (initial SOFA9 [interquartile range 4–12] vs. 4 [2–7]; maximal SOFA10 [5–13] vs. 5 [2–9]; total SOFA28 [10–70] vs. 9 [3–41]; mean SOFA7 [4–10] vs. 4 [2–6], all p < .001). The overall relationship between daily lactateAUC>2 and daily SOFA was an increase of 0.62 SOFA-points per 1 day·mmol/L of lactateAUC>2 (95% confidence interval, 0.41–0.81, p < .00001). During early intensive care unit stay, the relationship between lactateAUC>2 and SOFA was 1.01 (95% confidence interval, 0.53–1.50, p < .0005), and during late intensive care unit stay, this was reduced to 0.50 (95% confidence interval, 0.28–0.72, p < .0005). Respiratory (0.30, 0.22–0.38, p < .001) and coagulation (0.13, 0.09–0.18, p < .001) subscores were most strongly associated with lactateAUC>2.
CONCLUSIONS:Blood lactate levels were strongly related to SOFA scores. This relationship was stronger during the early phase of intensive care unit stay, which provides additional indirect support for early resuscitation to prevent organ failure. The results confirm that hyperlactatemia can be considered as a warning signal for organ failure. |
| doi_str_mv | 10.1097/CCM.0b013e3181a0f919 |
| format | Article |
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DESIGN:Retrospective observational study.
SETTING:Mixed intensive care unit of a university hospital.
PATIENTS:134 heterogeneous intensive care unit patients.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We calculated the area under the lactate curve above 2.0 mmol/L (lactateAUC>2). Daily SOFA scores were collected during the first 28 days of intensive care unit stay to calculate initial (day 1), maximal, total and mean scores. Daily lactateAUC>2 values were related to both daily SOFA scores and organ subscores using mixed-model analysis of variance. This was also done separately during the early (<2.75 days) and late (>2.75 days) phase of the intensive care unit stay.Compared with normolactatemic patients (n = 78), all median SOFA variables were higher in patients with hyperlactatemia (n = 56) (initial SOFA9 [interquartile range 4–12] vs. 4 [2–7]; maximal SOFA10 [5–13] vs. 5 [2–9]; total SOFA28 [10–70] vs. 9 [3–41]; mean SOFA7 [4–10] vs. 4 [2–6], all p < .001). The overall relationship between daily lactateAUC>2 and daily SOFA was an increase of 0.62 SOFA-points per 1 day·mmol/L of lactateAUC>2 (95% confidence interval, 0.41–0.81, p < .00001). During early intensive care unit stay, the relationship between lactateAUC>2 and SOFA was 1.01 (95% confidence interval, 0.53–1.50, p < .0005), and during late intensive care unit stay, this was reduced to 0.50 (95% confidence interval, 0.28–0.72, p < .0005). Respiratory (0.30, 0.22–0.38, p < .001) and coagulation (0.13, 0.09–0.18, p < .001) subscores were most strongly associated with lactateAUC>2.
CONCLUSIONS:Blood lactate levels were strongly related to SOFA scores. This relationship was stronger during the early phase of intensive care unit stay, which provides additional indirect support for early resuscitation to prevent organ failure. The results confirm that hyperlactatemia can be considered as a warning signal for organ failure.]]></description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0b013e3181a0f919</identifier><identifier>PMID: 19531949</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Biomarkers - blood ; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis ; Early Diagnosis ; Female ; Hospital Mortality ; Humans ; Intensive care medicine ; Intensive Care Units ; Lactic Acid - blood ; Male ; Medical sciences ; Middle Aged ; Multiple Organ Failure - mortality ; Multiple Organ Failure - prevention & control ; Netherlands - epidemiology ; Predictive Value of Tests ; Retrospective Studies ; ROC Curve ; Severity of Illness Index ; Survival Analysis ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><ispartof>Critical care medicine, 2009-08, Vol.37 (8), p.2369-2374</ispartof><rights>2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4467-8d4afac4b1a1977e9337ee0c9c4c76f0b7b46f04169ff35e4cb5c7a8fe077b393</citedby><cites>FETCH-LOGICAL-c4467-8d4afac4b1a1977e9337ee0c9c4c76f0b7b46f04169ff35e4cb5c7a8fe077b393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21766575$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19531949$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jansen, Tim C</creatorcontrib><creatorcontrib>van Bommel, Jasper</creatorcontrib><creatorcontrib>Woodward, Roger</creatorcontrib><creatorcontrib>Mulder, Paul G. H</creatorcontrib><creatorcontrib>Bakker, Jan</creatorcontrib><title>Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: A retrospective observational study</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description><![CDATA[OBJECTIVES:To evaluate whether the level and duration of increased blood lactate levels are associated with daily Sequential Organ Failure Assessment (SOFA) scores and organ subscores and to evaluate these associations during the early and late phases of the intensive care unit stay.
DESIGN:Retrospective observational study.
SETTING:Mixed intensive care unit of a university hospital.
PATIENTS:134 heterogeneous intensive care unit patients.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We calculated the area under the lactate curve above 2.0 mmol/L (lactateAUC>2). Daily SOFA scores were collected during the first 28 days of intensive care unit stay to calculate initial (day 1), maximal, total and mean scores. Daily lactateAUC>2 values were related to both daily SOFA scores and organ subscores using mixed-model analysis of variance. This was also done separately during the early (<2.75 days) and late (>2.75 days) phase of the intensive care unit stay.Compared with normolactatemic patients (n = 78), all median SOFA variables were higher in patients with hyperlactatemia (n = 56) (initial SOFA9 [interquartile range 4–12] vs. 4 [2–7]; maximal SOFA10 [5–13] vs. 5 [2–9]; total SOFA28 [10–70] vs. 9 [3–41]; mean SOFA7 [4–10] vs. 4 [2–6], all p < .001). The overall relationship between daily lactateAUC>2 and daily SOFA was an increase of 0.62 SOFA-points per 1 day·mmol/L of lactateAUC>2 (95% confidence interval, 0.41–0.81, p < .00001). During early intensive care unit stay, the relationship between lactateAUC>2 and SOFA was 1.01 (95% confidence interval, 0.53–1.50, p < .0005), and during late intensive care unit stay, this was reduced to 0.50 (95% confidence interval, 0.28–0.72, p < .0005). Respiratory (0.30, 0.22–0.38, p < .001) and coagulation (0.13, 0.09–0.18, p < .001) subscores were most strongly associated with lactateAUC>2.
CONCLUSIONS:Blood lactate levels were strongly related to SOFA scores. This relationship was stronger during the early phase of intensive care unit stay, which provides additional indirect support for early resuscitation to prevent organ failure. The results confirm that hyperlactatemia can be considered as a warning signal for organ failure.]]></description><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</subject><subject>Early Diagnosis</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Lactic Acid - blood</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multiple Organ Failure - mortality</subject><subject>Multiple Organ Failure - prevention & control</subject><subject>Netherlands - epidemiology</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><subject>Severity of Illness Index</subject><subject>Survival Analysis</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdksFu1DAQhiMEokvhDRDyhZ5IsWMnjrmtVhSQinoAztHEmbQGb7x4nF3l8XgzvO2KSvgy8sw3_4z8uyheC34puNHvN5uvl7znQqIUrQA-GmGeFCtRS17yysinxYpzw0upjDwrXhD95FyoWsvnxZkwtRRGmVXxZ00UrIPkwsR6TAfEHH0IA_NgEyRkHvfo6R37hr9nnJIDz27iLUzsCpyfI7IsgUTbXGM092RDxIzDNLCqLQdY2DbEBN6lhQ1zdNMtQ4h-uSf8cYKbEk7k9sgsZL15clkpwfKBrVnEFAPt0KZjPfSEcX-_bV6D0jwsL4tnI3jCV6d4Xvy4-vh987m8vvn0ZbO-Lq1SjS7bQcEIVvUChNEajZQakVtjldXNyHvdqxyUaMw4yhqV7WuroR2Ra91LI8-LiwfdXQz5ISh1W0cWvYcJw0xdo1XbtrrKoHoAbV6cIo7dLrotxKUTvDta12Xruv-ty21vTvpzv8XhsenkVQbengAgC36MMFlH_7hK6Kapdf04_xB8wki__HzA2N0h-HTX8XxkpZqyOv6ONt_KY0rLv5p1t5k</recordid><startdate>200908</startdate><enddate>200908</enddate><creator>Jansen, Tim C</creator><creator>van Bommel, Jasper</creator><creator>Woodward, Roger</creator><creator>Mulder, Paul G. H</creator><creator>Bakker, Jan</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200908</creationdate><title>Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: A retrospective observational study</title><author>Jansen, Tim C ; van Bommel, Jasper ; Woodward, Roger ; Mulder, Paul G. H ; Bakker, Jan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4467-8d4afac4b1a1977e9337ee0c9c4c76f0b7b46f04169ff35e4cb5c7a8fe077b393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</topic><topic>Early Diagnosis</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Lactic Acid - blood</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multiple Organ Failure - mortality</topic><topic>Multiple Organ Failure - prevention & control</topic><topic>Netherlands - epidemiology</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><topic>Severity of Illness Index</topic><topic>Survival Analysis</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jansen, Tim C</creatorcontrib><creatorcontrib>van Bommel, Jasper</creatorcontrib><creatorcontrib>Woodward, Roger</creatorcontrib><creatorcontrib>Mulder, Paul G. H</creatorcontrib><creatorcontrib>Bakker, Jan</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jansen, Tim C</au><au>van Bommel, Jasper</au><au>Woodward, Roger</au><au>Mulder, Paul G. H</au><au>Bakker, Jan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: A retrospective observational study</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2009-08</date><risdate>2009</risdate><volume>37</volume><issue>8</issue><spage>2369</spage><epage>2374</epage><pages>2369-2374</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract><![CDATA[OBJECTIVES:To evaluate whether the level and duration of increased blood lactate levels are associated with daily Sequential Organ Failure Assessment (SOFA) scores and organ subscores and to evaluate these associations during the early and late phases of the intensive care unit stay.
DESIGN:Retrospective observational study.
SETTING:Mixed intensive care unit of a university hospital.
PATIENTS:134 heterogeneous intensive care unit patients.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We calculated the area under the lactate curve above 2.0 mmol/L (lactateAUC>2). Daily SOFA scores were collected during the first 28 days of intensive care unit stay to calculate initial (day 1), maximal, total and mean scores. Daily lactateAUC>2 values were related to both daily SOFA scores and organ subscores using mixed-model analysis of variance. This was also done separately during the early (<2.75 days) and late (>2.75 days) phase of the intensive care unit stay.Compared with normolactatemic patients (n = 78), all median SOFA variables were higher in patients with hyperlactatemia (n = 56) (initial SOFA9 [interquartile range 4–12] vs. 4 [2–7]; maximal SOFA10 [5–13] vs. 5 [2–9]; total SOFA28 [10–70] vs. 9 [3–41]; mean SOFA7 [4–10] vs. 4 [2–6], all p < .001). The overall relationship between daily lactateAUC>2 and daily SOFA was an increase of 0.62 SOFA-points per 1 day·mmol/L of lactateAUC>2 (95% confidence interval, 0.41–0.81, p < .00001). During early intensive care unit stay, the relationship between lactateAUC>2 and SOFA was 1.01 (95% confidence interval, 0.53–1.50, p < .0005), and during late intensive care unit stay, this was reduced to 0.50 (95% confidence interval, 0.28–0.72, p < .0005). Respiratory (0.30, 0.22–0.38, p < .001) and coagulation (0.13, 0.09–0.18, p < .001) subscores were most strongly associated with lactateAUC>2.
CONCLUSIONS:Blood lactate levels were strongly related to SOFA scores. This relationship was stronger during the early phase of intensive care unit stay, which provides additional indirect support for early resuscitation to prevent organ failure. The results confirm that hyperlactatemia can be considered as a warning signal for organ failure.]]></abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>19531949</pmid><doi>10.1097/CCM.0b013e3181a0f919</doi><tpages>6</tpages></addata></record> |
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| ispartof | Critical care medicine, 2009-08, Vol.37 (8), p.2369-2374 |
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| subjects | Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Biomarkers - blood Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis Early Diagnosis Female Hospital Mortality Humans Intensive care medicine Intensive Care Units Lactic Acid - blood Male Medical sciences Middle Aged Multiple Organ Failure - mortality Multiple Organ Failure - prevention & control Netherlands - epidemiology Predictive Value of Tests Retrospective Studies ROC Curve Severity of Illness Index Survival Analysis Transfusions. Complications. Transfusion reactions. Cell and gene therapy |
| title | Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: A retrospective observational study |
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