Prognostic Value of Admission Lactate Levels in Critically Ill Patients: A Comparative Study With Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II Scores.

Autor:	Kumrawat A; General Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, IND., Gupta S; General Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, IND., Dhillon HS; General Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, IND., Kumrawat P; Anaesthesia, Uttar Pradesh University of Medical Sciences, Saifai, IND.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Oct 13; Vol. 16 (10), pp. e71372. Date of Electronic Publication: 2024 Oct 13 (Print Publication: 2024).
DOI:	10.7759/cureus.71372
Abstrakt:	Introduction Critical illness refers to life-threatening conditions requiring mechanical or pharmacological intervention to maintain organ function. Prognostic models, such as the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, have been widely used to predict mortality in intensive care unit (ICU) patients. Lactate levels are emerging as a valuable biomarker in this context. This study aims to determine the prognostic value of lactate levels upon admission in critically ill patients and to assess their correlation with SOFA and APACHE II scores. Methods This descriptive cross-sectional study included 200 critically ill patients admitted to the emergency department over one year. Data on patient demographics, clinical findings, and laboratory results were collected, and lactate levels and SOFA and APACHE II scores were measured at the time of admission. Patients were followed throughout their hospital stay, with outcomes classified as survival or mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of lactate, SOFA, and APACHE II scores. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States). Results The mean age of the patients was 56.8±16.9 years; 110 (55%) were men, and 90 (45%) were women. In total, 79 patients (39.5%) were non-survivors, and 121 (60.5%) were survivors. Lactate levels were significantly higher in non-survivors (3.56±1.90 mmol/L) compared to survivors (1.47±0.82 mmol/L) (p<0.001). The SOFA and APACHE II scores were also significantly higher in non-survivors (SOFA: 6.35±3.19; APACHE II: 19.91±8.21) than in survivors (SOFA: 3.14±2.02; APACHE II: 12.45±5.76) (p<0.001). The ROC curve analysis showed that lactate had an area under the curve (AUC) of 0.909, SOFA had an AUC of 0.809, and APACHE II had an AUC of 0.769 for predicting mortality. Conclusions Lactate levels are a highly sensitive predictor of mortality in critically ill patients, with significant correlations to SOFA and APACHE II scores. Lactate, as a single rapid test, provides substantial prognostic information and can aid in early triage and clinical decision-making, particularly in resource-limited settings. A single arterial lactate measurement at admission is an effective tool for predicting patient outcomes in the ICU. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee of Maharishi Markandeshwar Institute of Medical Sciences and Research issued approval IEC/2518/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Kumrawat et al.)
Databáze:	MEDLINE
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