The Impact of Serum Glucose on the Predictive Value of Serum Lactate for Hospital Mortality in Critically Ill Surgical Patients

Abstract

Background Lactate has been widely used as a risk indicator of outcomes in critically ill patients due to its ready measurement and good predictive ability. However, the interconnections between lactate metabolism and glucose metabolism have not been sufficiently explored, yet. In this study, we aimed to investigate whether glucose levels could influence the predictive ability of lactate and design a more comprehensive strategy to assess the in-hospital mortality of critically ill patients. Methods We analyzed the clinical data of 293 critically ill patients. The primary outcome was in-hospital mortality. The logistic regression analysis and the area under the receiver operating characteristic curve (AUROC) were applied to evaluate the predictive ability of lactate in association with glucose. Results The lactate level showed significant association with in-hospital mortality, and its predictive ability was also comparable to other prognostic scores such as the SOFA score and APACHE II score. We further divided 293 patients into three groups based on glucose levels: low-glucose group (<7 mmol/L), medium-glucose group (7-9 mmol/L), and high-glucose group (>9 mmol/L). The lactate level was associated with in-hospital mortality in the low- and high- glucose groups, but not in the medium-glucose group, whereas the SOFA score and APACHE II score were associated with in-hospital mortality in all three glucose groups. The AUROC of lactate in the medium-glucose group was also the lowest among the three glucose groups, indicating a decrease in its predictive ability. Conclusions Our findings demonstrated that the predictive ability of lactate to assess in-hospital mortality could be influenced by glucose levels. In the medium glucose level (i.e., 7-9 mmol/L), lactate was inadequate to predict in-hospital mortality and the SOFA score; the APACHE II score should be utilized as a complementation in order to obtain a more accurate prediction.

Risk Factors for 28-Day Mortality in a Surgical ICU: A Retrospective Analysis of 347 Cases

“… 9 An elevated lactate level is a poor indicator of survival in critically ill patients. 10 , 11 However, whether it is an independent risk factor for mortality in surgical ICU remains unknown. Thus, there is an urgent need for evaluations of risk factors associated with mortality in surgical ICU.…”

Physiological and Pathological Evaluation of Mechanically Ventilated Anesthetized Pigs

“…Mortality is strongly correlated with blood glucose and serum lactate levels. A study of critically ill patients (Chen et al 2019) found that the mortality rate was approximately 23% when serum lactate was higher than 2.3mmol/l and approximately 10% when blood glucose was lower than 70mg/dL (Freire Jorge et al 2017). During the first 24h after admission, the coincidence of low glucose and high serum lactate was associated with a high risk of acute kidney injury, liver dysfunction, and hospital mortality (Freire Jorge et al 2017).…”

Predicting Lactate Elevation in Neonatal Cardiac Surgery: Can the Sugars be Overlooked?

“…1,6 Interestingly, Chen et al reveal an extended impact of the blood glucose levels on the inhospital mortality predictive value of serum lactate in critically ill surgical subset. 7 Chen et al describe that the serum lactate levels predicts mortality in the hypoglycemic (<7 mmol/L) and the hyperglycemic groups (>9 mmol/L) but not in the normoglycemic (7-9 mmol/L) study group. 5,7 The concerns about neonatal organ immaturity concomitant with low-flow states also complicate the authors' analysis.…”

“…7 Chen et al describe that the serum lactate levels predicts mortality in the hypoglycemic (<7 mmol/L) and the hyperglycemic groups (>9 mmol/L) but not in the normoglycemic (7-9 mmol/L) study group. 5,7 The concerns about neonatal organ immaturity concomitant with low-flow states also complicate the authors' analysis.…”