Lactate is associated with mortality in very old intensive care patients suffering from COVID-19 : results from an international observational study of 2860 patients
Bruno, Raphael Romano (Heinrich-Heine-University Duesseldorf)
Wernly, Bernhard (Paracelsus Medical University)
Flaatten, Hans (Haukeland University Hospital (Bergen, Noruega))
Fjølner, Jesper (Aarhus University Hospital (Aarhus, Dinamarca))
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Bollen Pinto, Bernardo (Geneva University Hospitals)
Schefold, Joerg C. (University of Bern)
Binnebössel, Stephan (Heinrich-Heine-University Duesseldorf)
Baldia, Philipp Heinrich (Heinrich-Heine-University Duesseldorf)
Kelm, Malte (Heinrich-Heine-University Duesseldorf)
Beil, Michael (Hebrew University of Jerusalem)
Sigal, Sivri (Hebrew University of Jerusalem)
van Heerden, Peter Vernon (Hebrew University of Jerusalem)
Szczeklik, Wojciech (Jagiellonian University Medical College)
Elhadi, Muhammed (University of Tripoli)
Joannidis, Michael (Medical University Innsbruck)
Oeyen, Sandra (Universitair Ziekenhuis Gent)
Zafeiridis, Tilemachos (General University Hospital of Larissa (Grècia))
Wollborn, Jakob (Brigham and Women's Hospital (Boston, Estats Units d'Amèrica))
Arche Banzo, Maria José (Hospital Clínico Universitario "Lozano Blesa" de Zaragoza)
Fuest, Kristina (Technical University of Munich)
Marsh, Brian (Mater Misericordiae University Hospital)
Andersen, Finn H. (Norwegian University of Science and Technology)
Moreno, Rui (Centro Hospitalar Universitário de Lisboa Central)
Leaver, Susannah (St George'S University Hospitals NHS Foundation Trust)
Boumendil, Ariane (Hôpital Saint-Antoine)
De Lange, Dylan W. (University Utrecht)
Guidet, Bertrand (Hôpital Saint-Antoine)
Jung, Christian (Heinrich-Heine-University Duesseldorf)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020. This prospective international observation study (The COVIP study) recruited patients aged 70 years or older (ClinicalTrials. gov ID: NCT04321265) admitted to an intensive care unit (ICU) with COVID-19 disease from March 2020 to February 2021. In addition to serial lactate values (arterial blood gas analysis), we recorded several parameters, including SOFA score, ICU procedures, limitation of care, ICU- and 3-month mortality. A lactate concentration ≥ 2. 0 mmol/L on the day of ICU admission (baseline) was defined as abnormal. The primary outcome was ICU-mortality. The secondary outcomes 30-day and 3-month mortality. In total, data from 2860 patients were analyzed. In most patients (68%), serum lactate was lower than 2 mmol/L. Elevated baseline serum lactate was associated with significantly higher ICU- and 3-month mortality (53% vs. 43%, and 71% vs. 57%, respectively, p < 0. 001). In the multivariable analysis, the maximum lactate concentration on day 1 was independently associated with ICU mortality (aOR 1. 06 95% CI 1. 02-1. 11; p = 0. 007), 30-day mortality (aOR 1. 07 95% CI 1. 02-1. 13; p = 0. 005) and 3-month mortality (aOR 1. 15 95% CI 1. 08-1. 24; p < 0. 001) after adjustment for age, gender, SOFA score, and frailty. In 826 patients with baseline lactate ≥ 2 mmol/L sufficient data to calculate the difference between maximal levels on days 1 and 2 (∆ serum lactate) were available. A decreasing lactate concentration over time was inversely associated with ICU mortality after multivariate adjustment for SOFA score, age, Clinical Frailty Scale, and gender (aOR 0. 60 95% CI 0. 42-0. 85; p = 0. 004). In critically ill old intensive care patients suffering from COVID-19, lactate and its kinetics are valuable tools for outcome prediction. Trial registration number : NCT04321265. The online version contains supplementary material available at 10. 1186/s13613-021-00911-8.
Ajuts:	European Commission. Horizon 2020 831644
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Annals of Intensive Care, Vol. 11 (august 2021) , ISSN 2110-5820

DOI: 10.1186/s13613-021-00911-8
PMID: 34417919

9 p, 1.0 MB

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