Prediction of Inhospital Mortality in Critically Ill Patients With Sepsis: Confirmation of the Added Value of 24-Hour Lactate to Acute Physiology and Chronic Health Evaluation IV

Overview

Journal Crit Care Explor

Specialty Critical Care

Date 2022 Sep 9

PMID 36082375

Authors

Meryem Baysan

Mendi S Arbous

Ewout W Steyerberg

Johanna G van der Bom

Affiliations

Soon will be listed here.

Abstract

Derivation Cohort: The derivation cohort from Leiden, The Netherlands, consisted of 451 critically ill patients with sepsis.

Validation Cohort: The validation cohort consisted of 4,440 critically ill adult patients with sepsis from the Medical Information Mart for Intensive Care cohort admitted to the ICU of Beth Israel Deaconness Medical Center, Boston, MA, between January 2006 and 2018.

Prediction Model: Predictors of mortality were: age, chronic comorbidities, length of stay pre-ICU, Glasgow Coma Scale, and Acute Physiology Score. Lactate concentration at 24-hour alone, in combination with 24-hour lactate clearance and in combination with lactate concentration at admission, was added to assess improvement of the prediction model. The outcome was inhospital mortality.

Results: Inhospital mortality occurred in 160 patients (36%) in the derivation cohort and in 2,347 patients (53%) in the validation cohort. The Acute Physiology and Chronic Health Evaluation (APACHE) IV model had a moderate discriminative performance (recalibrated -statistic, 0.62; 95% CI, 0.60-0.63). Addition of 24-hour lactate concentration increased the recalibrated -statistic to 0.64 (95% CI, 0.62-0.66). The model with 24-hour lactate concentration and lactate concentration at admission showed the best fit as depicted by the smallest Akaike Information Criterion in both the derivation and validation data.

Conclusion: The 24-hour lactate concentration and lactate concentration at admission contribute modestly to prediction of inhospital mortality in critically ill patients with sepsis. Future updates and possible modification of APACHE IV should consider the incorporation of lactate concentration at baseline and at 24 hours.

Citing Articles

Interpretable machine learning-based prediction of 28-day mortality in ICU patients with sepsis: a multicenter retrospective study.

Shen L, Wu J, Lan J, Chen C, Wang Y, Li Z Front Cell Infect Microbiol. 2025; 14():1500326.

PMID: 39844844 PMC: 11751000. DOI: 10.3389/fcimb.2024.1500326.

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