[Effect of lactic acid levels on the prognosis of critically ill patients after cardiac and non-cardiac surgery: an analysis of 549 cases].
0
Citation
0
Reference
10
Related Paper
Abstract:
To compare the impact of mean lactate concentration and lactate variability on postoperative outcome after cardiac surgery and non-cardiac surgery in critical patients, and to explore the prognostic value of the first lactate and the highest lactate during the first 24 hours in intensive care unit (ICU).A retrospective study was conducted. The postoperative patients of cardiac surgery and non-cardiac surgery who were transferred to ICU immediately, and who were at least 18 years old and whose ICU lengths of stay were at least 1 day, and who were admitted to ICU of the First Affiliated Hospital of Zhengzhou University from September 2014 to September 2016 were enrolled. According to the mean lactate concentration, the patients were divided into normal lactate group (0-2 mmol/L), relatively high lactate group (2-4 mmol/L), and absolute high lactate group (> 4 mmol/L), and the relationship between the mean lactate concentration and the prognosis of patients was analyzed. According to the degree of lactate variability, the patients were divided into four groups, and multivariate regression models were used to assess the risk of death in three different lactate variability groups. The value of the first lactate value and the highest lactate value during the first 24 hours in ICU were evaluated to predict the prognosis by the receiver operating characteristic (ROC) curve.268 postoperative patients of cardiac surgery and 281 cases of non-cardiac surgery were selected, and the characteristic of the baseline data in the two groups was balanced. (1) Mean lactate concentration and mortality in ICU: in the normal lactate group (0-2 mmol/L), there was no significant difference in mortality between the post-cardiac operative group and post-non-cardiac operative group [7.9% (14/177) vs. 6.5% (14/217), odds ratio (OR) = 1.245, P = 0.694]. In the relatively high lactate group (2-4 mmol/L), there was no significant difference between the two groups, either [33.3% (12/36) vs. 23.7% (9/38), OR = 1.611, P = 0.442]. In the absolute high lactate group (> 4 mmol/L), ICU mortality in post-non-cardiac operative group was obviously higher than that of post-cardiac operative group [69.2% (18/26) vs. 43.6% (24/55), OR = 0.344, P = 0.036]. (2) The ranges of lactate variability per quartile (mmol×L-1×d-1) and ICU mortality risk: there was a linear relationship between lactate variability and ICU mortality in post-non-cardiac operative group, < 0.50 (reference), 0.50-0.85 (OR = 1.17, P = 0.87), 0.85-1.44 (OR = 4.86, P = 0.04), > 1.44 (OR = 22.66, P < 0.01) , and there was a significant difference between the two groups in the high degree of variability (0.85-1.44 and > 1.44). The risk of death after cardiac surgery tended to increase, < 0.55 (reference), 0.55-1.25 (OR = 0.61, P = 0.61), 1.25-2.43 (OR = 3.46, P = 0.10), > 2.43 (OR = 12.14, P < 0.01), and the risk of death only showed difference in the highest degree of variation (> 2.43). (3) ROC curve showed that the area under ROC curves (AUC) of the highest lactate in 24 hours were larger than that of the first lactate in both groups, with higher sensitivity and specificity. In the post-cardiac operative group and post-non-cardiac operative group, the AUC of the highest lactate in the first 24 hours were 0.877 and 0.875, the cut-off values were 5.35 mmol/L and 5.65 mmol/L, the sensitivity were 81.4% and 67.9%, and the specificity were 93.8% and 96.1%, respectively.Patients with post-non-cardiac operation should be more active in controlling hyperlactatemia and lactate variability. The highest lactate in the first 24 hours maybe one of the indicator for the assessment of the prognosis of the postoperative patients.Keywords:
Hyperlactatemia
The dysnatremias (hyponatremia and hypernatremia) are relatively common findings on admission of intensive care unit (ICU) patients and may represent a major risk. The aim of the study was to assess the ability of serum sodium levels and the Acute Physiology and Chronic Health Evaluation II (APACHE II) to predict mortality of surgical critically ill patients.One hundred and ninety-five surgical patients (62% males and 38% females; mean age of 51.8 ± 17.3 years) admitted to the ICU in the postoperative phase were retrospectively studied. The patients were divided into survivors (n = 152) and non-survivors (n = 43). APACHE II, and serum sodium levels at admission, 48 h and discharge were analyzed by generation of receiver operating characteristic (ROC) curves.The mean APACHE II was 16.3 ± 8.3 (13.6 ± 6.1 for survivors and 25.5 ± 8.5 for non-survivors). The area under the ROC curve for APACHE II was 0.841 (0.782 - 0.889) and 0.721 (0.653 - 0.783), 0.754 (0.653 - 0.783) and 0.720 (0.687 - 0.812) for serum sodium level at admission, 48 h and discharge, respectively.Even though APACHE II scoring system was the most effective index to predict mortality in the surgical critically ill patients, the serum sodium levels on admission may also be used as an independent predictor of outcome.
Hypernatremia
Cite
Citations (15)
Abstract Background The original Logistic Organ Dysfunction Sore (LODS) excluded cardiac surgery patients from its target population, and the suitability of this score in cardiac surgery patients has never been tested. We evaluated the accuracy of the LODS and the usefulness of its daily measurement in cardiac surgery patients. The LODS is not a true logistic scoring system, since it does not use β-coefficients. Methods This prospective study included all consecutive adult patients who were admitted to the intensive care unit (ICU) after cardiac surgery between January 2007 and December 2008. The LODS was calculated daily from the first until the seventh postoperative day. Performance was assessed with Hosmer-Lemeshow (HL) goodness-of-fit test (calibration) and receiver operating characteristic (ROC) curves (discrimination) from ICU admission day until day 7. The outcome measure was ICU mortality. Results A total of 2801 patients (29.6% female) with a mean age of 66.4 ± 10.7 years were included. The ICU mortality rate was 5.2% (n = 147). The mean stay on the ICU was 4.3 ± 6.8 days. Calibration of the LODS was good with no significant difference between expected and observed mortality rates on any day (p ≥ 0.05). The initial LODS had an area under the ROC curve (AUC) of 0.81. The AUC was best on ICU day 3 with a value of 0.93, and declined to 0.85 on ICU day 7. Conclusions Although the LODS has not previously been validated for cardiac surgery patients it showed reasonable accuracy in prediction of ICU mortality in patients after cardiac surgery.
Cardiothoracic surgery
Youden's J statistic
Cite
Citations (25)
ABSTRACT Objective To evaluate the agreement between the modified version of the Nutritional Risk in the Critically Ill Score (without Interleukin-6) and a variant composed of C-Reactive Protein as well as its capacity to predict mortality. Methods A prospective cohort study was carried out with 315 patients in an Intensive Care Unit of a university hospital from October 2017 to April 2018. The agreement between the instruments was evaluated using the Kappa test. The predictive capacity for estimating mortality was assessed with the Receiver Operating Characteristic curve. Results The critical patients involved in the study had a mean age of 60.8±16.3 years and 53.5% were female. Most patients had C-Reactive Protein levels ?10mg/dL (n=263, 83.5%) and their admission in the Intensive Care Unit was medical (n=219, 69.5%). The prevalence of mortality was observed in 41.0% of the evaluated patients. The proportions at high nutritional risk according to Nutritional Risk in the Critically Ill without Interleukin-6 and with C-Reactive Protein were 57.5% and 55.6%, respectively. The tools showed strong and significant agreement(Kappa=0.935; p=0.020) and satisfactory performances in predicting mortality (area under the curve 0.695 [0.636-0.754] and 0.699 [0.640-0.758]). Conclusion Both versions of the Nutritional Risk in the Critically Ill tool show a satisfactory agreement and performance as predictors of mortality in critically ill patients. Further analysis of this variant and the association between nutrition adequacy and mortality is needed.
Risk of mortality
Kappa
Cite
Citations (0)
Risk stratification allows preoperative assessment of cardiac surgical risk faced by individual patients and permits retrospective analysis of postoperative complications in the intensive care unit (ICU). The aim of this single-center study was to investigate the prediction of extended ICU stay after cardiac surgery using both the additive and logistic model of the European System for Cardiac Operative Risk Evaluation (EuroSCORE).A retrospective observational study was conducted. We collected clinical data of 1562 consecutive patients undergoing cardiac surgery over a 2-year period at the Antwerp University Hospital, Belgium. EuroSCORE values of all patients were obtained. The outcome measure was the duration of ICU stay in days. The predictive performance of EuroSCORE was analyzed by the discriminatory power of a receiver operating characteristic (ROC) curve. Each EuroSCORE value was used as a theoretical cut-off point to predict duration of ICU stay. Three subsequent ICU stays were defined as prolonged: more than 2, 5 and 7 days. ROC curves were constructed for both the additive and logistic model.Patients had a median ICU stay of 2 days and a mean ICU stay of 5.5 days. Median additive EuroSCORE was 5 (range, 0-22) and logistic EuroSCORE was 3.94% (range, 0.00-87.00). In the additive EuroSCORE model, a predictive value of 0.76 for an ICU stay of >7 days, 0.72 for >5 days and 0.67 for >2 days was found. The logistic EuroSCORE model yielded an area under the ROC curve of 0.77, 0.75 and 0.68 for each ICU length of stay, respectively.In our patient database, prolonged length of stay in the ICU correlated positively with EuroSCORE. The logistic model was more discriminatory than the additive in tracing extended ICU stay. The overall predictive performance of EuroSCORE is acceptable and most likely based on the presence of variables that are risk factors for both mortality and extended ICU stay. Hence, EuroSCORE is a useful predicting tool and provides both surgeons and intensivists with a good estimate of patient risk in terms of ICU stay.
EuroSCORE
Cite
Citations (52)
Introduction: Blood lactate levels are suggested as more important parameter to evaluate patient condition particularly in critical illness. Aim: The aim of this study is to find a relation between lactate levels and hospital fatal outcome in critical illness. Methods: This was a prospective observational study in 125 critical ill-patients admitted in intensive care unit. Serial serum lactate levels were estimated from the time of admission for every 24 h and the results were correlated with Acute Physiology and Chronic Health Evaluation II (APACHE) score and fatal outcome. Results: Non-survivors (n = 32, 25%) had significantly higher lactate levels than survivors at the time of admission (137.5 mg/dl vs. 37.7 mg/dl). Fatal outcome rate was significantly higher in patients with lactate levels 100 mg/dl or higher when compared with lactate levels below 100 mg/dl. A significant positive correlation was observed between APACHE II scores and admission lactate levels in nonsurvivors.
Cite
Citations (2)
Objective To explore the relationship between dynamic lactic acid monitoring and pediatric critical illness score (PCIS) and clinical significance.Methods PCIS of 77 critically ill children admitted into pediatric intensive care unit (PICU) were recorded after hospitalization.According to PCIS,all the children were divided into extremely critical group (23 cases),critical group (32 cases),non-critical group (22 cases),according to prognosis,all the children were divided into surrival group (55 cases) and death group (22 cases).Blood concentration of lactic acid were detected.Differences in their lactic acid indexes (including lactic acid level after admission to PICU,peak lactic acid level) and PCIS were compared,their correlation and prognosis of critid death group (22 cases) cally ill children were analyzed.Results Lactic acid level after admission to PIC U [ (5.28 ± 3.69) mmol/L ] and peak lactic acid level [(8.54 ± 4.32 )mmol/L] in extremely critical group were significantly higher than those in critical group and non-critical group (P ＜ 0.05 ),but PCIS [ (65.79 ± 2.34) scores ] was significantly lower than that in critical group and non-critical group (P ＜0.05).Lactic acid indexes in death group were significantly higher than those in survival group (P ＜ 0.05 or ＜ 0.01 ),but PCIS was significantly lower than that in survival group (P ＜ 0.05 ).PCIS was negative correlated with lactic acid level (P ＜ 0.01 ).Conclusions Critically ill children with elevated lactic acid indexes are worse and poorer prognosis.PCIS score can effectively evaluate children's condition and prognosis,and compared with lactic acid level linear correlation is existed.Dynamic lactic acid monitoring indexes are the good factors for the severe degree and predicting the prognosis of the critically ill children.
Key words:
Lactic acid; Critical illness; Prognosis
Cite
Citations (0)
Background: Risk stratification models allow preoperative assessment of individual patients cardiac surgical risk and enable analysis of postoperative outcome in the intensive care unit (ICU) as well. Objectives: The aim of this single-center study was to explore the prediction of extended ICU stay after cardiac surgery using the European System for Cardiac Operative Risk Evaluation (Euro SCORE). Patients and Methods: A retrospective cross-sectional study was conducted. We collected clinical data of 1841 consecutive patients undergoing cardiac surgery. The outcome measure was the duration of ICU stay in days. The predictive performance of Euro SCORE was analyzed by the discriminatory power of a receiver operating characteristic (ROC) curve. Results: Overall observed mortality was 3.5% (57/1841). Patients had a median ICU stay of 3 days and a mean ICU stay of 3.1 days. Mean additive Euro SCORE was 4.36% (range: 0-21) and logistic Euro SCORE was 4.81% (range: 0.88-44.28). The logistic Euro SCORE model yielded an area under the ROC curve of 0.832, 0.768 and 0.643 for each ICU length of stay, respectively (7, 5, 3 days). Values of Euro SCORE and ICU stay were positively correlated (P < 0.001). Conclusions: In our center, prolonged length of stay in the ICU correlated positively with Euro SCORE. The overall predictive performance of Euro SCORE is acceptable and provides both surgeons and intensivists with a good estimate of patient risk in terms of ICU stay.
Single Center
Cite
Citations (3)
Background Several cardiac surgery risk prediction models based on postoperative data have been developed. However, unlike preoperative cardiac surgery risk prediction models, postoperative models are rarely externally validated or utilized by clinicians. The objective of this study was to externally validate three postoperative risk prediction models for intensive care unit (ICU) mortality after cardiac surgery. Methods The logistic Cardiac Surgery Scores (logCASUS), Rapid Clinical Evaluation (RACE), and Sequential Organ Failure Assessment (SOFA) scores were calculated over the first 7 postoperative days for consecutive adult cardiac surgery patients between January 2013 and May 2015. Model discrimination was assessed using receiver operating characteristic curve analyses. Calibration was assessed using the Hosmer–Lemeshow (HL) test, calibration plots, and observed to expected ratios. Recalibration of the models was performed. Results A total of 2255 patients were included with an ICU mortality rate of 1.8%. Discrimination for all three models on each postoperative day was good with areas under the receiver operating characteristic curve of >0.8. Generally, RACE and logCASUS had better discrimination than SOFA. Calibration of the RACE score was better than logCASUS, but ratios of observed to expected mortality for both were generally <0.65. Locally recalibrated SOFA, logCASUS and RACE models all performed well. Conclusion All three models demonstrated good discrimination for the first 7 days after cardiac surgery. After recalibration, logCASUS and RACE scores appear to be most useful for daily risk prediction after cardiac surgery. If appropriately calibrated, postoperative cardiac surgery risk prediction models have the potential to be useful tools after cardiac surgery.
Cite
Citations (11)
Objective To investigate the prognostic value of intra abdominal pressure(IAP) in critically ill patients in intensive care unit(ICU).Methods This was a prospective cohort study and patients were from intensive care unit in Nanjing Gulou hospital.Intraabdominal pressure was measured twice daily via the bladder for 7 days.Receiver operating characteristic(ROC) was used to predict the prognosis.Results IAP decreased in survivors and increased in the death,especially at the 5th,6th and 7th day(P0.05 or P0.01).Logistic regression identified IAP at 7th day as an independent predictor of mortality(OR=1.278,95%CI 1.065-1.534,P=0.008).By using receiver operating characteristic analysis,the area under the curve was 0.771±0.041 at 7th day,however the APACHE Ⅱ score was 0.921±0.021 and SAPS score was 0.914±0.021(P0.05 or P0.01).The cutoff value of IAP on prognosis was 12.13 mm Hg,with the sensitivity 43.9% and specificity 94.4%.Conclusion IAP dynamics observation can be one of the factors for predicting the prognosis of critically ill patients.
Cut-off
SAPS II
Cite
Citations (0)
Aim: To assess the prognostic value for 28-day mortality of PSP in critically ill patients with sepsis. Material & methods: 122 consecutive patients with sepsis were enrolled in this study. Blood samples were collected on admission and day 2. Results: On admission, the combination of PSP and lactate achieved an area under the receiver operating characteristic (AUC-ROC) of 0.796, similar to sequential organ failure assessment score alone (AUC-ROC: 0.826). On day 2, PSP was the biomarker with the highest performance (AUC-ROC: 0.844), although lower (p = 0.041) than sequential organ failure assessment score (AUC-ROC: 0.923). Conclusion: The combination of PSP and lactate and PSP alone, on day 2, have a good performance for prognosis of 28-day mortality and could help to identify patients who may benefit most from tailored intensive care unit management.
Cite
Citations (22)