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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; Wernly, Bernhard; Flaatten, Hans; Fjølner, Jesper; Artigas, Antonio; Bollen Pinto, Bernardo; Schefold, Joerg C; Binnebössel, Stephan; Baldia, Philipp Heinrich; Kelm, Malte; Beil, Michael; Sigal, Sivri; van Heerden, Peter Vernon; Szczeklik, Wojciech; Elhadi, Muhammed; Joannidis, Michael; Oeyen, Sandra; Zafeiridis, Tilemachos; Wollborn, Jakob; Arche Banzo, Maria José; Fuest, Kristina; Marsh, Brian; Andersen, Finn H; Moreno, Rui; Leaver, Susannah; Boumendil, Ariane; De Lange, Dylan W; Guidet, Bertrand; Jung, Christian.
  • Bruno RR; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
  • Wernly B; Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
  • Flaatten H; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
  • Fjølner J; Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
  • Artigas A; Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
  • Bollen Pinto B; Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
  • Schefold JC; Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
  • Binnebössel S; Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland.
  • Baldia PH; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
  • Kelm M; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
  • Beil M; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
  • Sigal S; Deptartment of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • van Heerden PV; Deptartment of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Szczeklik W; General Intensive Care Unit, Deptartment of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Elhadi M; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
  • Joannidis M; Faculty of Medicine, University of Tripoli, Tripoli, Libya.
  • Oeyen S; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
  • Zafeiridis T; Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
  • Wollborn J; Intensive Care Unit General Hospital of Larissa, Larissa, Greece.
  • Arche Banzo MJ; Department of Anesthesiolgy, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
  • Fuest K; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
  • Marsh B; Department of Anesthesiology and Intensive Care, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany.
  • Andersen FH; Mater Misericordiae University Hospital, Dublin, Ireland.
  • Moreno R; Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.
  • Leaver S; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
  • Boumendil A; Unidade de Cuidados Intensivos Neurocríticos E Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Lisbon, Portugal.
  • De Lange DW; General Intensive Care, St George´S University Hospitals NHS Foundation Trust, London, UK.
  • Guidet B; Institut Pierre Louis D'Epidémiologie Et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, 75012, Paris, France.
  • Jung C; Assistance Publique-Hôpitaux de Paris, service de réanimation médicale, Hôpital Saint-Antoine, 75012, Paris, France.
Ann Intensive Care ; 11(1): 128, 2021 Aug 21.
Article in English | MEDLINE | ID: covidwho-1367683
ABSTRACT

PURPOSE:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Ann Intensive Care Year: 2021 Document Type: Article Affiliation country: S13613-021-00911-8

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Ann Intensive Care Year: 2021 Document Type: Article Affiliation country: S13613-021-00911-8