TY - JOUR
T1 - Lactate is associated with mortality in very old intensive care patients suffering from COVID-19
T2 - results from an international observational study of 2860 patients
AU - COVIP Study Group
AU - Bruno, Raphael Romano
AU - Wernly, Bernhard
AU - Flaatten, Hans
AU - Fjølner, Jesper
AU - Artigas, Antonio
AU - Bollen Pinto, Bernardo
AU - Schefold, Joerg C
AU - Binnebössel, Stephan
AU - Baldia, Philipp Heinrich
AU - Kelm, Malte
AU - Beil, Michael
AU - Sigal, Sivri
AU - van Heerden, Peter Vernon
AU - Szczeklik, Wojciech
AU - Elhadi, Muhammed
AU - Joannidis, Michael
AU - Oeyen, Sandra
AU - Zafeiridis, Tilemachos
AU - Wollborn, Jakob
AU - Arche Banzo, Maria José
AU - Fuest, Kristina
AU - Marsh, Brian
AU - Andersen, Finn H
AU - Moreno, Rui
AU - Leaver, Susannah
AU - Boumendil, Ariane
AU - De Lange, Dylan W
AU - Guidet, Bertrand
AU - Jung, Christian
AU - Dieperink, Willem
N1 - © 2021. The Author(s).
PY - 2021/12/1
Y1 - 2021/12/1
N2 - 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.
AB - 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.
KW - blood lactate
KW - covid-19
KW - elderly patients
KW - critical care
KW - covid-19
KW - intensive zorg
KW - oudere patiënten
U2 - 10.1186/s13613-021-00911-8
DO - 10.1186/s13613-021-00911-8
M3 - Article
C2 - 34417919
SN - 2110-5820
VL - 11
JO - Annals of Intensive Care
JF - Annals of Intensive Care
IS - 1
M1 - 128
ER -