Prognostic value of blood gas lactate levels among COVID-19 patients who visited to emergency department

Abstract

Objective: Our aim in this study, to determine the relationship between the mortality status and the ICU requirement of COVID-19 patients, with their blood gas lactate levels at the time of admission to the ED. Material and method: This study was planned as retrospectively, all COVID-19 patients over the age of 18 who were admitted to the ED, had oropharyngeal /nasopharyngeal swabs and hospitalized between April 1, 2020 and June 31, 2020 were included. The primary outcome was in-hospital mortality. The secondary outcome is to determine the relationship between lactate levels and the ICU requirement Results: The study was completed with 265 patients after the inclusion and exclusion criteria were applied. The median (IQR) age of the patients was 43.0 (31.0 – 59.0), and 132 (49.8%) were female. The comorbid diseases are; hypertension (HT), cardiovascular disease and diabetes mellitus (DM) were in the first three places with 23.0%, 17.0%, 9.1%, respectively. The cut-off value of lactate to determined for ICU admissions was 2.92, and 4.25 for mortality.The AUC for ICU requirement was 0.718 ± 0.038 (95% CI, 0.644 - 0.792), and AUC for mortality was 0.752 ± 0.058 (95% CI, 0.637 - 0.867), (p <0.001 for both). Conclusions: The COVID-19 pandemic has caused a serious mortality and morbidity problem worldwide. Our study found that hyperlactatemic COVID-19 patients had higher ICU requirement and mortality rates.

Keywords

• covid-19
• lactate
• prognostic
• mortality

References

1. Gürbüz T, Gökmen O, Kaptan G, et al. Investigating anxiety, depression and obsessive-compulsive disorders among the pregnant women during Covid-19 pandemic. J Health Sci Med 2021; 4: 7-12.
2. Seyhan AU, Doganay F, Yilmaz E, Topal NP, Ak R. Investigation of QT prolongation with hydroxychloroquine and azithromycin for the treatment of COVID-19. J Coll Physicians Surg Pak 2020; 30: 153-7.
3. COVID Live Update: 157,636,912 Cases and 3,286,500 Deaths from the Coronavirus - Worldometer. https://www.worldometers.info/coronavirus
4. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet 2020; 395: 497-506.
5. Phua J, Weng L, Ling L, et al. Asian Critical Care Clinical Trials Group. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. The Lancet Res Med 2020; 8: 506-17.
6. Doğanay F, Elkonca F, Seyhan AU, Yılmaz E, Batırel A, Ak R. Shock index as a predictor of mortality among the Covid-19 patients. Am J Emerg Med 2021; 40: 106-9.
7. Mikkelsen ME, Miltiades AN, Gaieski DF, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock.Crit care Med 2009; 37: 1670-7.
8. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet 2020; 395: 1054-62.

9. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475-81.
10. Sanyaolu A, Okorie C, Marinkovic A, et al. Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med 2020; 1-8.
11. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020: 55-5.
12. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet 2020; 395: 1054-62.
13. İbrahim A, Bayramoglu B, Hokenek NM, et al. Lactate clearance during the first 2 hours after hospital admission: A useful biomarker for predicting 30‐day mortality in patients with diabetic ketoacidosis. Int J Clin Pract 2021; e14204.
14. Hökenek NM, Seyhan AU, Erdoğan MÖ, Tekyol D, Yılmaz E, Korkut S. Evaluation of blood gas analysis as a mortality predictor. S Clin Ist Eur 2019; 30-3.
15. Sakal C, Ak R, Taşçı A, Deniz KE, Akoğlu EU, Cimilli OT. Admission blood lactate levels of patients diagnosed with cerebrovascular disease effects on short and long‐term mortality risk. Int J Clin Prac 2021; e14161.
16. Juneja D, Singh O, Dang R. Admission hyperlactatemia: causes, incidence, and impact on outcome of patients admitted in a general medical intensive care unit. J Crit Care 2011; 26: 316-20.
17. Chen YX, Li CS. Lactate on emergency department arrival as a predictor of mortality and site-of-care in pneumonia patients: a cohort study. Thorax 2015; 70: 404-10.
18. Contenti J, Corraze H, Lemoël F, Levraut J. Effectiveness of arterial, venous, and capillary blood lactate as a sepsis triage tool in ED patients. Am J Emerg Med 2015; 33: 167–72.