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 - 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
N1 - Funding Information:
The COVIP study group consists of the authors and the following persons: Philipp Eller, Michael Joannidis, Dieter Mesotten, Pascal Reper, Sandra Oeyen, Walter Swinnen, Nicolas Serck, Elisabeth Dewaele, Edwin Chapeta, Helene Brix, Jens Brushoej, Pritpal Kumar, Helene Korvenius Nedergaard, Tim Koch Johnsen, Camilla Bundesen, Maria Aagaard Hansen, Stine Uhrenholt, Helle Bundgaard, Jesper Fjølner, Richard Innes, James Gooch, Lenka Cagova, Elizabeth Potter, Michael Reay, Miriam Davey, Mohammed Abdelshafy Abusayed, Sally Humphreys, Amy Collins, Avinash Aujayeb, Susannah Leaver, Waqas Khaliq, Ayman Abdelmawgoad Habib, Mohammed A Azab, Kyrillos Wassim.
Funding Information:
Open Access funding enabled and organized by Projekt DEAL. This study was endorsed by the ESICM. Free support for running the electronic database and was granted from the dep. of Epidemiology, University of Aarhus, Denmark. The support of the study in France by a Grant from Fondation Assistance Publique-Hôpitaux de Paris pour la recherche is greatly appreciated. In Norway, the study was supported by a grant from the Health Region West. In addition, the study was supported by a Grant from the European Open Science Cloud (EOSC). EOSCsecretariat.eu has received funding from the European Union’s Horizon Programme call H2020-INFRAEOSC-05-2018-2019, Grant Agreement Number 831644. This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-University Düsseldorf, and No. 2020-21 to RRB for a Clinician Scientist Track.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/8/21
Y1 - 2021/8/21
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.
UR - http://www.scopus.com/inward/record.url?scp=85113310427&partnerID=8YFLogxK
U2 - 10.1186/s13613-021-00911-8
DO - 10.1186/s13613-021-00911-8
M3 - Article
C2 - 34417919
SN - 2110-5820
VL - 11
SP - 1
EP - 9
JO - Annals of Intensive Care
JF - Annals of Intensive Care
IS - 1
M1 - 128
ER -