Association Between Lactate and 28-Day Mortality in Elderly Patients with Sepsis: Results from MIMIC-IV Database

Abstract

Introduction This study aimed to explore the association of serum lactate with clinical outcomes in elderly patients with sepsis based on data from the MIMIC-IV database. Methods All elderly patients with sepsis (age ≥ 65 years) were included. Different models were constructed for exploring the relationships between lactate and 28-day mortality. A two-segment linear regression model was performed to verify the threshold effects of lactate on clinical outcomes and smooth curve fitting was performed. Results A total of 4199 elderly patients with sepsis were included. The 28-day mortality was 32.22% ( n = 1395). After adjustment for all potential cofounders, for each 1 mmol/l increment in lactate, the odds ratio (OR) of 28-day mortality was 1.23 (95% CI 1.18–1.28, P < 0.0001). Smooth fitting curves indicated a non-linear positive relationship between lactate and 28-day mortality. The turning point of lactate level was 5.7 mmol/l: at ≤ 5.7 mmol/l, with each 1 mmol/l increment in lactate, the risk of 28-day mortality increased significantly (OR 1.32, 95% CI 1.25–1.38, P < 0.0001); the significantly positive relationship was still present at lactate > 5.7 mmol/l (OR 1.10, 95% CI 1.04–1.18, P = 0.0019). The area under the ROC curve (AUC) of lactate was 0.618 (95% CI 0.599–0.635) and the cutoff value of lactate was 2.4 mmol/l with a sensitivity of 0.483 and a specificity of 0.687. Conclusion In elderly patients with sepsis, a non-linear positive relationship was discovered between serum lactate and 28-day mortality. Physicians should be alert to lactate assessment at admission and pay more attention to those patients with higher levels of lactate. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00736-3.

Early Blood Lactate as a Biomarker for Cardiovascular Collapse in Experimental Sepsis

“…Blood lactate levels are important predictors of severity and prognosis in human sepsis (8,10). Although sepsis experimental studies often assay blood lactate, most assay it in only one time point or as an indicator that the animal is septic.…”

“…Blood lactate levels are important predictors of severity and prognosis in human sepsis (8,10). Although sepsis experimental FIG.…”

“…Serum lactate level is a sensitive indicator of metabolic stress (6,7) and is a marker of worsened blood perfusion that has been used to characterize sepsis and septic shock diagnostics and prognostics in the clinical setting (8). Recent research has showed a positive association between higher levels of lactate and increased mortality of sepsis/septic shock (9,10). Because lactate can be quickly and easily measured in laboratory animals, it may be a promising biomarker of cardiovascular collapse in experimental sepsis.…”

Risk factors and incidence of sepsis-induced coagulopathy in patients with sepsis: a single- center retrospective cohort study

“…A large retrospective study found that lactate ≥ 4 mmol/l was not only associated with short-term prognosis of sepsis, but also with 1-year mortality [44]. The higher the level of lactate was, the higher the risk of 28-day mortality in elderly patients with sepsis was [45]. Isolated hyperlactatemia has been shown to increase the risk of 90-day mortality in sepsis patients by 1.7 times [46].…”

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