Value, time and outcomes of elevated lactate levels in adult patients on extracorporeal membrane oxygenation.

INTRODUCTION: Lactate levels have been recognized as a reliable tool for monitoring critically ill patients requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) or venovenous extracorporeal membrane oxygenation (VV ECMO) but the reasons behind the overproduction of lactate are different and the influance for survival remains controversial. We analyzed the lactate values and lactate clearance in adult patients in these two forms of extracorporeal support. METHODS: Patient demographics, ECMO duration, 30-day mortality, lactate values and lactate clearance at 24, 48 and 72 h from ECMO initiation of patients supported with VV and VA ECMO at Silesian Centre for Heart Deasese, between January 2011 and April 2020 were retrospectively analyzed. The changes in lactate levels were analyzed using the non-parametric U Mann-Whitney tests and Chi-square test. The ROC curves were draw and the area under the curve was calculated. RESULTS: The study comprised 91 adult patients, Mortality in the first 30 days from initiation of VV and VA ECMO was 39% and 66%, respectively. Lactate levels were significantly higher in non-survivors that received VV and VA ECMO (p < .001), while lactate clearance was similar (p = .256 and p = 1.000, respectively). Survival curves for patients with elevated (>2.0 mmol/L) vs normal (≤2.0 mmol/L) lactate levels at 72 h were significantly different for VV ECMO (p = .007) and VA ECMO (p = .037) but in both groups of ECMO, lactate levels above 2.0 mmol/L at 72 h from ECMO initiation predicted 30 day-mortality. CONCLUSION: This results emphasized the importance of lactate levels below 2.0 mmol/L at 72 h from both VV and VA ECMO initiation.

Factors influencing death in COVID-19 patients treated in the ICU: a single-centre, cross-sectional study.

BACKGROUND: This single-centre study investigated factors influencing death in coronavirus disease 2019 (COVID-19) patients treated in an intensive care unit (ICU). METHODS: Data of 113 consecutive patients with a severe form of COVID-19 infection, who completed their ICU stay in a large COVID-19-dedicated hospital in the Silesian Region of Poland during one year of the pandemic (between 10 March, 2020 and 10 March, 2021), were reviewed. Comprehensive comparison of all available ICU pre-admission, admission and treatment variables was performed. Variables that independently influenced ICU death were identified. RESULTS: ICU mortality in the whole group was 64.6%. Mean age was higher in non-survivors (64.6 ± 9.5 vs. 60.0 ± 12.8 years, P = 0.036), but the distribution of sex and body mass index was similar in both groups. Non-survivors had a marginally higher mean Charlson Comorbidity Index (5.9 ± 3.6 vs. 4.5 ± 4.1 points, P = 0.063), and significantly higher mean Clinical Frailty Score (4.8 ± 1.5 vs. 3.9 ± 1.4 points, P = 0.004), admission APACHE II score (22.9 ± 7.9 vs. 19.1 ± 7.8 points, P = 0.017) and SAPS II score (62.1 ± 18.1 vs. 54.0 ± 16.7 points, P = 0.023). Factors that independently influenced ICU death were limited to: admission total protein 2.0 ng mL-1 (OR = 11.3, P = 0.026) and lactate level > 2.0 mmol L-1 (OR = 4.2, P = 0.003) as well as Clinical Frailty Score ≥ 5 points (OR = 3.1, P = 0.021). CONCLUSIONS: The presence of low total protein, frailty and increased procalcitonin and lactate levels at ICU admission are associated with ICU death in patients with severe COVID-19 infection.

Intensive Care Unit Admissions During the First 3 Months of the COVID-19 Pandemic in Poland: A Single-Center, Cross-Sectional Study.

BACKGROUND Data on the outcomes of patients with coronavirus disease 2019 (COVID-19) requiring Intensive Care Unit (ICU) care in Poland are limited. There are no data on critically ill patients with COVID-19 who did not meet criteria for ICU admission. MATERIAL AND METHODS We analyzed patients admitted to the ICU and those ineligible for ICU admission in a large COVID-19-dedicated hospital, during the first 3 months of the pandemic in Poland. Data from 67 patients considered for ICU admissions due to COVID-19 infection, treated between 10 March and 10 June 2020, were reviewed. Following exclusions, data on 32 patients admitted to the ICU and 21 patients ineligible for ICU admission were analyzed. RESULTS In 38% of analyzed patients, symptoms of COVID-19 infection occurred during a hospital stay for an unrelated medical issue. The mean age of ICU patients was 62.4 (10.4) years, and the majority of patients were male (69%), with at least one comorbidity (88%). The mean admission APACHE II and SAPS II scores were 20.1 (8.1) points and 51.2 (15.3) points, respectively. The Charlson Comorbidity Index and Clinical Frailty Scale were lower in ICU patients compared with those disqualified: 5.9 (4.3) vs. 9.1 (3.5) points, P=0.01, and 4.7 (1.7) vs. 6.9 (1.2) points, P<0.01, respectively. All ICU patients required intubation and mechanical ventilation. ICU mortality was 67%. Hospital mortality among patients admitted to the ICU and those who were disqualified was 70% and 79%, respectively. CONCLUSIONS Patients with COVID-19 requiring ICU admission in our studied population were frail and had significant comorbidities. The outcomes in this group were poor and did not seem to be influenced by ICU admission.