Introduction
Material and methods
Patient selection
Blood sample collection and measurement
SOFA score
Data analysis
Results
Patient characteristics
Characteristics | Survivors (n = 667) | Non-survivors (n = 40) | P value |
---|---|---|---|
Age, years, mean | 57.2 (35.7–69.8) | 60.7 (39.3–82.6) | 0.09 |
SBP at triage, mmHg | 146.5 (124.6–189.9) | 141.4 (104.6–198.5) | 0.93 |
DBP at triage, mmHg | 85.1 (55.6–101.7) | 78.7 (44.1–99.5) | 079 |
SOFA score | 4 (0–6) | 9 (5–23) | < 0.001 |
Episodes of hypotension, n (%) | 86 (12.90) | 19 (47.50) | < 0.01 |
Hypothermia (BT < 36), n (%) | 78 (11.70) | 10 (25.0) | 0.56 |
Hyperthermia (BT ≥ 38), n (%) | 150 (22.49) | 9 (22.50) | 0.94 |
Acidosis, n (%) | 106 (16.04) | 10 (25.0) | < 0.001 |
Coagulopathy, n (%) | 95 (14.24) | 11 (27.5) | < 0.001 |
Thrombocytopenia, n (%) | 69 (10.34) | 7 (17.5) | 0.23 |
Anemia, n (%) | 88 (13.19) | 11 (27.50) | 0.08 |
Episode of SpO2 < 90%, n (%) | 65 (9.75) | 6 (15.0) | 0.07 |
Blood lactate (mmol/l) | 2.8 (0.5–5.6) | 6.6 (1.2–11.8) | < 0.001 |
Serum albumin (g/dl) | 3.1 (2.1–4.8) | 2.6 (1.9–3.6) | < 0.001 |
Serum creatinine (mg/dl) | 1.7 (0.5–3.8) | 2.4 (0.9–6.6) | < 0.01 |
Serum glucose (mg/dl) | 163 (121.5–188.9) | 192 (128.6–246.5) | < 0.01 |
CRP (mg/dl) | 124.1 (56.1–174.5) | 161.7 (65.8–205.6) | < 0.01 |
Diabetes mellitus, n (%) | 193 (28.94) | 14 (35.0) | 0.26 |
Liver cirrhosis, n (%) | 141 (21.14) | 13 (32.5) | 0.15 |
Chronic kidney disease, n (%) | 207 (31.03) | 14 (35.0) | 0.34 |
Comparison of data in NF patients with different concentrations of blood lactate
Admission blood lactate, mmol/l | 0.0–2.0 | 2.1–4.0 | 4.1–6.0 | 6.1–8.0 | > 8.0 | P value |
---|---|---|---|---|---|---|
n
| 145 | 275 | 141 | 84 | 62 | |
Age, years | 56.1 (30.1–68.9) | 57.1 (35.9–71.2) | 57.8 (33.8–75.1) | 59.3 (41.9–79.2) | 60.3 (42.3–85.6) | < 0.001 |
SBP at triage, mmHg | 137.4 (115.8–175.6) | 134.5 (115.4–189.7) | 130.8 (106.8–174.3) | 125.7 (105.2–170.9) | 124.8 (103.6–168.7) | 0.61 |
DBP at triage, mmHg | 87.6 (51.8–120.5) | 85.4 (52.4–117.9) | 82.7 (50.7–115.6) | 79.5 (42.7–114.2) | 76.9 (40.9–108.1) | 0.18 |
Episode of hypotension, n (%) | 12 (10.3) | 30 (10.9) | 23 (16.3) | 19 (22.6) | 21 (33.9) | < 0.001 |
SOFA score | 3 (0–6) | 4 (0–6) | 5 (1–7) | 7 (2–9) | 9 (4–16) | < 0.001 |
Hypothermia (BT < 36), n (%) | 15 (10.3) | 33 (12.0) | 18 (12.8) | 14 (13.1) | 8 (12.5) | 0.74 |
Hyperthermia (BT > =38), n (%) | 33 (22.8) | 70 (25.5) | 28 (19.9) | 17 (20.2) | 11 (17.7) | 0.56 |
Acidosis, n (%) | 10 (6.9) | 34 (12.4) | 26 (18.4) | 25 (29.8) | 21 (33.9) | < 0.001 |
Coagulopathy, n (%) | 16 (11.0) | 36 (13.1) | 22 (15.6) | 17 (20.2) | 15 (24.2) | < 0.001 |
Thrombocytopenia, n (%) | 13 (9.0) | 26 (9.5) | 11 (7.8) | 15 (17.9) | 11 (18.4) | 0.22 |
Anemia, n (%) | 18 (12.4) | 37 (13.5) | 19 (13.5) | 14 (16.7) | 11 (18.5) | 0.96 |
Episode of SpO2 < 90%, n (%) | 11 (7.6) | 25 (10.2) | 17 (12.1) | 11 (13.1) | 7 (11.9) | 0.77 |
In-hospital mortality, n (%) | 3 (2.1) | 6 (2.2) | 7 (5.0) | 11 (13.1) | 13 (21.0) | < 0.001 |
Serum albumin (g/dl) | 3.8 (2.6–4.1) | 3.7 (2.4–4.6) | 3.5 (2.1–3.9) | 3.1 (2.1–3.5) | 2.8 (1.8–3.4) | < 0.001 |
Serum creatinine (mg/dl) | 1.1 (0.4–2.8) | 1.3 (0.5–2.9) | 1.7 (0.9–3.8) | 2.1 (1.1–5.6) | 2.5 (1.4–7.9) | < 0.01 |
Serum glucose (mg/dl) | 128 (94–159) | 136 (93–166) | 158 (101–196) | 169 (105–201) | 184 (117–243) | < 0.01 |
Serum CRP (mg/dl) | 98 (15–124) | 112 (29–161) | 135 (35–184) | 169 (51–196) | 198 (81–230) | < 0.01 |
Diabetes mellitus, n (%) | 38 (26.2) | 61 (24.9) | 51 (36.1) | 31 (36.9) | 26 (42.3) | 0.06 |
Liver cirrhosis, n (%) | 24 (16.6) | 45 (18.5) | 32 (22.7) | 29 (34.5) | 24 (38.9) | 0.08 |
Chronic kidney disease, n (%) | 39 (26.9) | 69 (28.2) | 50 (35.5) | 33 (39.3) | 30 (48.7) | < 0.001 |
Association of blood lactate level with in-hospital mortality
Univariate binary logistic regression | Multivariate logistic regression | |||
---|---|---|---|---|
OR (95% CI) | P value | OR (95% CI) | P value | |
Age | 1.02 (0.96–1.08) | 0.542 | 1.06 (0.96–1.16) | 0.249 |
SOFA score | 1.28 (1.06–1.51) | < 0.001 | 1.15 (1.11–1.20) | < 0.001e |
Episode of hypotension | 1.03 (1.01–1.05) | 0.001 | 1.11 (0.63–1.97) | 0.715 |
Episode of SpO2 < 90% | 1.58 (1.07–2.33) | 0.325 | 1.14 (1.02–1.18) | 0.459 |
Acidosis | 1.05 (1.01–1.08) | < 0.001 | 1.03 (0.94–1.12) | 0.217 |
Coagulopathy | 1.01 (1.00–1.01) | 0.001 | 1.02 (1.01–1.08) | 0.428 |
Thrombocytopenia | 1.03 (0.98–1.08) | 0.556 | 1.01 (0.93–1.03) | 0.829 |
Anemia | 1.05 (1.02–1.10) | 0.065 | 0.99 (0.98–1.01) | 0.913 |
Hypothermia | 1.01 (1.00–1.01) | 0.213 | 1.03 (0.98–1.07) | 0.541 |
Hyperthermia | 1.12 (1.02–1.15) | 0.968 | 1.02 (1.01–1.12) | 0.280 |
Blood lactate | 1.35 (1.30–1.46) | < 0.001a | 1.17 (1.07–1.29) | < 0.001b, c |
Serum glucose | 1.09 (1.01–1.23) | < 0.01 | 1.94 (0.76–4.75) | 0.580 |
Serum albumin | 0.86 (0.83–0.89) | < 0.001d | 0.92 (0.88–0.96) | < 0.001d |
Serum CRP | 1.11 (1.08–1.13) | < 0.001 | 1.24 (1.18–3.27) | 0.086 |
Serum creatinine | 1.01 (1.00–1.01) | < 0.001 | 1.12 (0.89–2.35) | 0.306 |
Diabetes mellitus | 1.05 (1.02–1.06) | 0.133 | 1.18 (1.02–1.29) | 0.102 |
Liver cirrhosis | 1.02 (1.00–1.03) | 0.506 | 1.05 (1.01–1.09) | 0.020 |
Chronic kidney disease | 1.02 (1.00–1.02) | < 0.01 | 1.14 (1.05–1.18) | 0.061 |
Ability of blood lactate level to predict in-hospital mortality
AUC | 95% CI | P value | Optimal cutoff value | Sensitivity (%) | Specificity (%) | |
---|---|---|---|---|---|---|
Blood lactate | 0.79 | 0.74–0.84 | < 0.001 | 5.8 mmol/l | 62 | 86 |
SOFA score | 0.82 | 0.78–0.86 | < 0.001 | 7.2 | 67 | 83 |
Blood lactate combined with SOFA score | 0.86 | 0.83–0.90 | < 0.001 | 64 | 93 |
ED lactate, mmol/l | ORa (95% CI) | P value | Sensitivity (%) | Specificity (%) | LR+ | LR− | PV+ | PV− |
---|---|---|---|---|---|---|---|---|
> 2.0 | 2.95 (2.27–8.96) | < 0.001 | 92 | 26 | 1.3 | 0.23 | 0.55 | 0.80 |
> 4.0 | 4.15 (3.72–9.32) | < 0.001 | 68 | 68 | 2.1 | 0.41 | 0.70 | 0.70 |
> 6.0 | 8.02 (6.51–15.27) | < 0.001 | 57 | 85 | 4.9 | 0.52 | 0.84 | 0.66 |
> 8.0 | 12.36 (10.54–22.01) | < 0.001 | 45 | 96 | 10.1 | 0.56 | 0.91 | 0.63 |