Research Article
BibTex RIS Cite

Blood Lactate Levels Intensive Care Patients Mortality Estimating, How much?

Year 2017, Volume: 14 Issue: 1, 12 - 28, 28.04.2017

Abstract

Background: This study’s aim was to show the blood lactate levels how effective mortality prediction of
the patients hospitalized in the Intensive Care Unit.
Materials and Methods: After obtaining the approval of the relevant ethics committee files of 114 patients
hospitalized in Muğla Sıtkı Koçman University Intensive Care Unit in 2015 were analyzed retrospectively.
Results: The mean age of the 114 patients was 62.78±20.43 ; %59.6 was male and %40.4 was female.
The research group has an associated co-morbid disease in %75.4. The average length of stay of patients
was 10.85±13.17 per day and %31.6 patients were died. The mean age of study group, APACHE II score,
SOFA score, a statistically significant relationship between mortality and high lactate levels and pH were
found out ( P<0.05). In univariate analysis multivariate logistic regression models were found to
significantly influence and examined by association with mortality. . APACHE II score (≥23.50) [OR=37.00
(5.35 – 255.75)], SOFA score (≥5.50) [OR=12.50 (4.21 – 37.04)], lactate output value (≥1.75mmol)
[OR=7.59 (3.34 – 17.22)] and ages (≥65.00) [OR=5.36 (2.09 – 13.71)] have been found to increased the
risk of mortality.
Conclusion: The blood lactate value in determining the prognosis of patients is as important as scoring
systems used in intensive care. Lactate is a good parameter that can be used to estimate mortality.

References

  • 1 Knaus WA, Wagner DP,Draper EA.Development of APACHE. CritCareMed 1989, 17: S181-S185.
  • 2. Vincent JL, MorenoR.Takala J, et al: The SOFA (Sepsis-related Organ Failure Assesment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-releated problems of the Europan Society of Intensive Care Medicine. IntensiveCareMed1996, 22: 707-710.
  • 3. Ball JAS, Redman JW, Grounds RM. Severity of illness Scoring Systems. In: Vincent JL,ed, Yearbook of Intensive CareMedicine. Berlin, Heidelberg: Springer-Verlag, 2006, pp 911-933.
  • 4. Wagner DP, Knaus WA, Draper EA. Statiscal validation of a severity of illness reasure. Am J PublicHealth1983, 73:878-884.
  • 5. Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al: Serum lactate as a predictor of mortality in emergency department patients with infection. AnnEmergMed 2005, 45(5):524-8.
  • 6. Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL: Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma 2009, 66(4):1040-4.
  • 7. Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB: Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. CritCare 2009, 13(3):R90. 8. Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al: Base excess and lactate as prognostic indicators for patients admitted to intensive care. IntensiveCareMed 2001, 27(1):74-83.
  • 9. del Portal DA, Shofer F, Mikkelsen ME, Dorsey PJ Jr, Gaieski DF, GoyalM,et al: Emergency department lactate is associated with mortality in older adults admitted with and without infections. AcadEmergMed 2010, 17(3):260-8.
  • 10. Vandromme MJ, Griffin RL, Weinberg JA, Rue LW, Kerby JD: Lactate is a beter predict orthan systolic blood pressure for determining blood requirement and mortality: could pre hospital measures improve traumatriage? J Am CollSurg 2010, 210(5):861-9.
  • 11. Kaplan LJ, Kellum JA: Comparison of acid-base models for prediction ofhospital mortality after trauma. Shock 2008, 29(6):662-6.
  • 12. Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA: Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA 2010, 303(8):739-46.
  • 13. vanBeest PA, Mulder PJ, Oetomo SB, van den Broek B, Kuiper MA, Spronk PE: Measurement of lactate in a prehospital setting is related to outcome. Eur J Emerg Med 2009, 16(6):318-22.
  • 14. Arnold RC, Shapiro NI, Jones AE, Schorr C, Pope J, Casner E, et al: Multicenterstudy of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock 2009, 32(1):35-9.
  • 15. Lee SW, Hong YS, Park DW, Choi SH, Moon SW, Park JS, et al: Lacticacidosis not hyperlactatemia as a predictor of in hospital mortality in septic emergency patients. EmergMed J 2008, 25(10):659-65.
  • 16. Jansen TC, van BJ, Mulder PG, Lima AP, van der Hoven B, Rommes JH, et al: Prognostic value of blood lactate levels: does the clinical diagnosis at admission matter? J Trauma 2009, 66(2):377-85
  • 17. Kliegel A, Losert H, Sterz F, Holzer M, Zeiner A, Havel C, et al: Serial lactate determinations for prediction of outcome after cardiac arrest. Medicine (Baltimore) 2004, 83(5):274- 9.
  • 18. Jansen TC, van BJ, Schoonderbeek FJ, SleeswijkVisser SJ, van der Klooster JM, Lima AP, et al: Early lactate-guided therapy in intensive care unit patients: a multicenter, openlabel, randomized controlled trial. Am J Respir Crit Care Med 2010, 182(6):752-61.
  • 19. Gallagher EJ, Rodriguez K, Touger M. Agreement between peripheral venous and arterial lactate levels. Ann Emerg Med 1997; 29: 479–83.
  • 20. Younger JG, Falk JL, Rothrock SG. Relationship between arterial and peripheral venous lactat levels. AcadEmergMed 1996; 3: 730–4.

Kan Laktat Seviyesi Yoğun Bakım Hastalarında Mortaliteyi Tahmin Etmede Ne Kadar Etkilidir?

Year 2017, Volume: 14 Issue: 1, 12 - 28, 28.04.2017

Abstract

Amaç: Bu çalışma ile Yoğun Bakım Ünitesinde yatan hastalarının mortalite tahmininde, kan laktat
değerlerinin ne kadar etkili olduğunu göstermek amaçlanmıştır.
Materyal ve Metod: Muğla Sıtkı Koçman Üniversitesi Anestezi Yoğun Bakım Ünitesinde 2015 yılında
yatan 114 hastanın dosyaları etik kurul onayı alındıktan sonra retrospektif olarak incelenmiştir. Hastaların
kayıtlı APACHE II, SOFA, giriş ve çıkış kan gazı analizleri değerlendirmeye alınmıştır.
Bulgular: Çalışmaya alınan 114 olgunun yaş ortalaması 62.78±20.43 olup; %59,6’sı erkek, %40,4’ü
kadındır. Araştırma grubunun %75,4’ünde eşlik eden bir yandaş hastalığı vardır. Hastaların ortalama yatış
süresi ortalama 10.85±13.17 gün olup, %31,6’sı exitus ile sonuçlanmıştır.
Araştırma grubunun yaş ortalaması, APACHE II skoru, SOFA skoru, laktat değeri ve çıkış pH değeri ile
mortalite arasında istatiksel olarak anlamlı derecede yüksek ilişki bulunmuştur (P<0.05). Araştırma
grubunda exitus olan olguların giriş ve çıkış kan değerleri arasındaki ilişkiye bakıldığında pH, laktat, HC03
değerleri ve APACHE II, SOFA skor ortalamalarıyla mortalite arasında istatiksel olarak anlamlı bir ilişki
bulunmuştur (P<0.05). Tek değişkenli analizlerde anlamlı bulunan değişkenler logistik regresyon modeline
alınmış ve mortalite ile ilişkisine göre etkisi incelendi. APACHE II skorunun (≥23.50) [OR=37.00 (5.35 –
255.75)], SOFA skorunun (≥5.50) [OR=12.50 (4.21 – 37.04)], çıkış laktat seviyesinin (≥1.75mmol) [OR=7.59 (3.34 – 17.22)] ve yaşın (≥65.00) [OR=5.36 (2.09 – 13.71)] mortalite riskini artırdığı
bulunmuştur.
Sonuç: Hastanın prognozunu belirlemede kan laktat değeri, yoğun bakımda kullanılan skorlama sistemleri
kadar önemlidir. Laktat mortalite tahmininde kullanılabilecek iyi bir parametredir.

References

  • 1 Knaus WA, Wagner DP,Draper EA.Development of APACHE. CritCareMed 1989, 17: S181-S185.
  • 2. Vincent JL, MorenoR.Takala J, et al: The SOFA (Sepsis-related Organ Failure Assesment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-releated problems of the Europan Society of Intensive Care Medicine. IntensiveCareMed1996, 22: 707-710.
  • 3. Ball JAS, Redman JW, Grounds RM. Severity of illness Scoring Systems. In: Vincent JL,ed, Yearbook of Intensive CareMedicine. Berlin, Heidelberg: Springer-Verlag, 2006, pp 911-933.
  • 4. Wagner DP, Knaus WA, Draper EA. Statiscal validation of a severity of illness reasure. Am J PublicHealth1983, 73:878-884.
  • 5. Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al: Serum lactate as a predictor of mortality in emergency department patients with infection. AnnEmergMed 2005, 45(5):524-8.
  • 6. Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL: Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma 2009, 66(4):1040-4.
  • 7. Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB: Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. CritCare 2009, 13(3):R90. 8. Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al: Base excess and lactate as prognostic indicators for patients admitted to intensive care. IntensiveCareMed 2001, 27(1):74-83.
  • 9. del Portal DA, Shofer F, Mikkelsen ME, Dorsey PJ Jr, Gaieski DF, GoyalM,et al: Emergency department lactate is associated with mortality in older adults admitted with and without infections. AcadEmergMed 2010, 17(3):260-8.
  • 10. Vandromme MJ, Griffin RL, Weinberg JA, Rue LW, Kerby JD: Lactate is a beter predict orthan systolic blood pressure for determining blood requirement and mortality: could pre hospital measures improve traumatriage? J Am CollSurg 2010, 210(5):861-9.
  • 11. Kaplan LJ, Kellum JA: Comparison of acid-base models for prediction ofhospital mortality after trauma. Shock 2008, 29(6):662-6.
  • 12. Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA: Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA 2010, 303(8):739-46.
  • 13. vanBeest PA, Mulder PJ, Oetomo SB, van den Broek B, Kuiper MA, Spronk PE: Measurement of lactate in a prehospital setting is related to outcome. Eur J Emerg Med 2009, 16(6):318-22.
  • 14. Arnold RC, Shapiro NI, Jones AE, Schorr C, Pope J, Casner E, et al: Multicenterstudy of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock 2009, 32(1):35-9.
  • 15. Lee SW, Hong YS, Park DW, Choi SH, Moon SW, Park JS, et al: Lacticacidosis not hyperlactatemia as a predictor of in hospital mortality in septic emergency patients. EmergMed J 2008, 25(10):659-65.
  • 16. Jansen TC, van BJ, Mulder PG, Lima AP, van der Hoven B, Rommes JH, et al: Prognostic value of blood lactate levels: does the clinical diagnosis at admission matter? J Trauma 2009, 66(2):377-85
  • 17. Kliegel A, Losert H, Sterz F, Holzer M, Zeiner A, Havel C, et al: Serial lactate determinations for prediction of outcome after cardiac arrest. Medicine (Baltimore) 2004, 83(5):274- 9.
  • 18. Jansen TC, van BJ, Schoonderbeek FJ, SleeswijkVisser SJ, van der Klooster JM, Lima AP, et al: Early lactate-guided therapy in intensive care unit patients: a multicenter, openlabel, randomized controlled trial. Am J Respir Crit Care Med 2010, 182(6):752-61.
  • 19. Gallagher EJ, Rodriguez K, Touger M. Agreement between peripheral venous and arterial lactate levels. Ann Emerg Med 1997; 29: 479–83.
  • 20. Younger JG, Falk JL, Rothrock SG. Relationship between arterial and peripheral venous lactat levels. AcadEmergMed 1996; 3: 730–4.
There are 19 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Gülseda Dede

Leyla Şahan This is me

Bahadır Dede

Semra Demirbilek

Publication Date April 28, 2017
Submission Date May 6, 2016
Acceptance Date July 17, 2016
Published in Issue Year 2017 Volume: 14 Issue: 1

Cite

Vancouver Dede G, Şahan L, Dede B, Demirbilek S. Kan Laktat Seviyesi Yoğun Bakım Hastalarında Mortaliteyi Tahmin Etmede Ne Kadar Etkilidir?. Harran Üniversitesi Tıp Fakültesi Dergisi. 2017;14(1):12-28.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty