Background
Methods
Study design and setting
Sample size calculation
Exposure: serum lactate
Outcome measures
Other factors
Statistical analysis
Results
Population characteristics
<2 mmol/L (N = 150) | 2–4 mmol/L (N = 150) | >4 mmol/L (N = 150) |
p-value | |
---|---|---|---|---|
Age (years) (Mean ± SD) | 64.87 ± 18.08 | 68.51 ± 18.01 | 67.46 ± 17.67 | 0.194 |
Male sex no.(%) | 78 (52.0) | 92 (61.3) | 86 (57.3) | 0.262 |
DM no.(%) | 43 (28.7) | 67 (44.7) | 77 (51.3) | <0.001 |
CAD no.(%) | 44 (29.3) | 48 (32.0) | 58 (38.7) | 0.210 |
CKD no.(%) | 32 (21.3) | 27 (18.0) | 34 (22.7) | 0.589 |
Metabolic illness no.(%) | 5 (3.3) | 0 (0.0) | 2 (1.3) | 0.063 |
Malignancy no.(%) | 50 (33.3) | 34 (22.7) | 45 (30.0) | 0.113 |
Recent surgery no.(%) | 3 (2.0) | 4 (2.7) | 9 (6.0) | 0.134 |
Medication use no.(%) | ||||
Metformin | 9 (6.0) | 29 (19.3) | 27 (18.0) | 0.001 |
Discharge diagnosis no.(%) | ||||
Infection | 119 (79.3) | 127 (84.7) | 115 (76.7) | 0.208 |
Trauma | 5 (3.3) | 7 (4.7) | 13 (8.7) | 0.111 |
Cardiogenic shock | 0 (0.0) | 0 (0.0) | 27 (18.0) | <0.001 |
MI | 1 (0.7) | 2 (1.3) | 10 (6.7) | 0.003 |
Stroke | 4 (2.7) | 3 (2.0) | 4 (2.7) | 0.911 |
Neurogenic shock | 0 (0.0) | 0 (0.0) | 3 (2.0) | 0.049 |
DKA | 0 (0.0) | 2 (1.3) | 4 (2.7) | 0.132 |
Ethanol toxicity | 1 (0.7) | 2 (1.3) | 1 (0.7) | 0.777 |
Acute limb ischemia | 3 (2.0) | 2 (1.3) | 3 (2.0) | 0.881 |
DVT | 0 (0.0) | 0 (0.0) | 3 (2.0) | 0.049 |
DIC | 0 (0.0) | 0 (0.0) | 2 (1.3) | 0.134 |
Obstetric emergenciesa
| 2 (1.3) | 0 (0.0) | 0 (0.0) | 0.134 |
Vital Signs and laboratory tests
<2 mmol/L (N = 150) | 2–4 mmol/L (N = 150) | >4 mmol/L (N = 150) |
p-value | |
---|---|---|---|---|
HR (bpm) (Mean ± SD) | 95.22 ± 21.27 | 100.69 ± 24.14 | 103.59 ± 23.74 | 0.007 |
RR (Breaths/min) (Mean ± SD) | 21.91 ± 5.54 | 22.09 ± 5.54 | 23.22 ± 6.11 | 0.110 |
SBP (mmHg) (Mean ± SD) | 120.03 ± 28.23 | 124.56 ± 28.54 | 114.13 ± 29.92 | 0.009 |
DBP (mmHg) (Mean ± SD) | 66.31 ± 17.88 | 67.31 ± 18.24 | 65.12 ± 22.06 | 0.626 |
O2 saturation (%) (Mean ± SD) | 95.09 ± 7.83 | 95.03 ± 9.28 | 93.37 ± 8.30 | 0.147 |
Temperature (°C) (Mean ± SD) | 37.23 ± 1.04 | 37.42 ± 1.04 | 37.05 ± 1.10 | 0.013 |
Lactate level (mmol/L) (Mean ± SD) | 1.42 ± 0.38 | 2.72 ± 0.55 | 7.18 ± 3.42 | <0.001 |
WBC (x109cells/L) (Mean ± SD) | 11,071.33 ± 6908.81 | 12,728.00 ± 6860.88 | 15,583.33 ± 12,135.99 | <0.001 |
Hemoglobin (mg/dl) (Mean ± SD) | 11.54 ± 3.37 | 11.58 ± 2.19 | 11.30 ± 2.56 | 0.640 |
Hematocrit (mg/dl) (Mean ± SD) | 33.46 ± 7.10 | 34.69 ± 6.55 | 34.30 ± 8.10 | 0.331 |
Arterial pH (Mean ± SD)a
| 7.35 ± 0.09 | 7.38 ± 0.09 | 7.31 ± 0.16 | 0.001 |
PaCO2 (mmHg) (Mean ± SD)a
| 41.63 ± 21.57 | 37.35 ± 13.22 | 34.98 ± 16.22 | 0.098 |
PaO2 (mmHg) (Mean ± SD)a
| 97.03 ± 47.74 | 97.45 ± 48.05 | 109.53 ± 70.75 | 0.350 |
Troponins (mg/dl) (Mean ± SD)b
| 0.10 ± 0.22 | 0.07 ± 0.12 | 0.11 ± 0.13 | 0.254 |
Creatinine (mg/dl) (Mean ± SD) | 1.63 ± 1.94 | 1.44 ± 1.35 | 1.90 ± 1.65 | 0.053 |
Length of stay and in-hospital mortality analysis
<2 mmol/L (N = 150) | 2–4 mmol/L (N = 150) | >4 mmol/L (N = 150) |
p-value | |
---|---|---|---|---|
Length of stay ED (hours) (Mean ± SD) | 11.83 ± 21.05 | 11.71 ± 13.04 | 16.49 ± 16.83 | 0.025 |
Length of stay Hospital (days) (Mean ± SD) | 7.80 ± 8.06 | 8.09 ± 8.78 | 10.36 ± 12.60 | 0.055 |
Mortality no.(%) | ||||
Hospital | 4 (2.7) | 18 (12.0) | 61 (40.7) | <0.001 |
72-h | 0 (0.0) | 0 (0.0) | 25 (16.7) | <0.001 |
Hospital mortality | |||||
---|---|---|---|---|---|
Lactate | <2 mmol/L (N = 150) | 2-4 mmol/L (N = 150) | >4 mmol/L (N = 150) |
P-value | |
Strata no.(%) | |||||
Age (years) | <65 | 2 (3.1) | 3 (6.8) | 18 (36.0) | <0.001 |
≥65 | 2 (2.3) | 15 (14.2) | 43 (43.0) | <0.001 | |
Infection | Yes | 2 (1.7) | 17 (13.4) | 47 (40.9) | <0.001 |
No | 2 (6.5) | 1 (4.3) | 14 (40.0) | <0.001 | |
SBP (mmHg) | SBP < 90 | 3 (15.0) | 2 (11.1) | 10 (35.7) | 0.092 |
SBP ≥ 90 | 1 (0.8) | 16 (12.1) | 44 (38.3) | <0.001 | |
Total | 4 (2.7) | 18 (12.0) | 61 (40.7) | <0.001 |
Lactate Group | Infection Status | Hospital Mortality |
p-value |
< 2 | No Yes | 2 (6.5%) 2 (1.7%) | 0.142 |
2–4 | No Yes | 1 (4.3%) 17 (13.4%) | 0.220 |
> 4 | No Yes | 14 (40.0%) 47 (40.9%) | 0.927 |
Lactate Group | SBP | Hospital Mortality |
p-value |
< 2 | <90 ≥90 | 3 (15.0%) 1 (0.8%) | <0.001 |
2–4 | <90 ≥90 | 2 (11.1%) 16 (12.1%) | 0.902 |
> 4 | <90 ≥90 | 10 (35.7%) 44 (38.3%) | 0.803 |
Lactate group | Age | Hospital Mortality |
p-value |
< 2 | <65 ≥65 | 2 (3.1%) 2 (2.3%) | 0.764 |
2–4 | <65 ≥65 | 3 (6.8%) 15 (14.2%) | 0.208 |
> 4 | <65 ≥65 | 18 (36.0%) 43 (43.0%) | 0.411 |
Crudea
| Adjustedb
| |||
---|---|---|---|---|
OR (Cl 95%) |
p-value | OR (Cl 95%) |
p-value | |
2-4 mmol/L | 4.97 (1.64–15.08) | 0.005 | 7.13 (2.22–22.87) | 0.001 |
>4 mmol/L | 25.02 (8.79–71.16) | <0.001 | 29.48 (9.75–89.07) | <0.001 |