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Dynamic lactate indices as predictors of outcome in critically ill patients.doc

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Dynamic lactate indices as predictors of outcome in critically ill patients

Nicholetal.CriticalCare2011,15:R242 /content/15/5/R242 RESEARCH OpenAccess Dynamiclactateindicesaspredictorsofoutcome incriticallyillpatients AlistairNichol1,3,MichaelBailey1,MoritokiEgi2,VillePettila1,CraigFrench5,4,EdwardStachowski6, MichaelCReade4,DavidJamesCooper1,3 andRinaldoBellomo1,4,7* Abstract Introduction:Dynamicchangesinlactateconcentrationsinthecriticallyillmaypredictpatientoutcomemore accuratelythanstaticindices.Weaimedtocomparethepredictivevalueofdynamicindicesoflactatemiainthe first24hoursofintensivecareunit(ICU)admissionwiththevalueofmorecommonlyusedstaticindices. Methods:Thiswasaretrospectiveobservationalstudyofaprospectivelyobtainedintensivecaredatabaseof5,041 consecutivecriticallyillpatientsfromfourAustralianuniversityhospitals.Weassessedtherelationshipbetween dynamiclactatevaluescollectedinthefirst24hoursofICUadmissionandbothICUandhospitalmortality. Results:Weobtained36,673lactatemeasurementsin5,041patientsinthefirst24hoursofICUadmission.Both thetimeweightedaveragelactate(LACTW24)andthechangeinlactate(LACΔ24)overthefirst24hourswere independentlypredictiveofhospitalmortalitywithbothrelationshipsappearingtobelinearinnature.Forevery oneunitincreaseinLACTW24 andLACΔ24 theriskofhospitaldeathincreasedby37%(OR1.37,1.29to1.45;P 0.0001)andby15%(OR1.15,1.10to1.20;P0.0001)respectively.Suchdynamicindices,whencombinedwith AcutePhysiologyandChronicHealthEvaluationII(APACHEII)scores,improvedoveralloutcomeprediction(P 0.0001)achievingalmost90%accuracy.Whenalllactatemeasuresinthefirst24hourswereconsidered,the combinationofLACTW24 andLACΔ24 significantlyoutperformed(P0.0001)staticindicesoflactateconcentration, suchasadmissionlactate,maximumlactateandminimumlactate. Conclusions:Inthefirst24hoursfollowingICUadmission,dynamicindicesofhyperlactatemiahavesignificant independentpredictivevalue,improvetheperformanceofillnessseverityscore-basedoutcomepredictionsand aresuperiortosimplestaticindicesoflactateconcentration. Keywords:lactate,hyperlactaemia,dynamic,inten