Lactate is associated with mortality in very old intensive care patients suffering from COVID-19: results from an international observational study of 2860 patients.
Lactate is associated with mortality in very old intensive care patients suffering from COVID-19: results from an international observational study of 2860 patients.
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乳酸盐与患有COVID-19的高龄重症监护患者的死亡率相关：来自2860名患者的国际观察性研究结果
DOI：
10.1186/s13613-021-00911-8
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发表时间：
2021-08-21
影响因子：
8.1
通讯作者：
COVIP Study Group
中科院分区：
文献类型：
--
作者：
Bruno RR;Wernly B;Flaatten H;Fjølner J;Artigas A;Bollen Pinto B;Schefold JC;Binnebössel S;Baldia PH;Kelm M;Beil M;Sigal S;van Heerden PV;Szczeklik W;Elhadi M;Joannidis M;Oeyen S;Zafeiridis T;Wollborn J;Arche Banzo MJ;Fuest K;Marsh B;Andersen FH;Moreno R;Leaver S;Boumendil A;De Lange DW;Guidet B;Jung C;COVIP Study Group
乳酸盐是重症监护中的一种既定促凝剂。然而，关于其在预测COVID-19结果中的作用的证据仍然不足。这对于在2020年最初激增期间受影响最大的老年患者尤其令人担忧。这项前瞻性国际观察研究（COVIP研究）招募了2020年3月至2021年2月期间因COVID-19疾病入住重症监护室（ICU）的70岁或以上患者（ClinicalTrials.gov ID：NCT 04321265）。除了连续乳酸值（动脉血气分析），我们还记录了几个参数，包括SOFA评分、ICU程序、护理限制、ICU和3个月死亡率。ICU入院当天（基线）乳酸盐浓度≥ 2.0 mmol/L定义为异常。主要结局为ICU死亡率。次要结局为30天和3个月死亡率。共分析了2860例患者的数据。大多数患者（68%）血清乳酸低于2 mmol/L。基线血清乳酸水平升高与ICU和3个月死亡率显著升高相关（分别为53% vs. 43%和71% vs. 57%，p < 0.001）。在多变量分析中，第1天的最大乳酸浓度与ICU死亡率独立相关（aOR 1.06 95% CI 1.02-1.11; p = 0.007），30天死亡率在校正年龄、性别、SOFA评分和虚弱后，患者的死亡率（aOR 1.07 95% CI 1.02-1.13; p = 0.005）和3个月死亡率（aOR 1.15 95% CI 1.08-1.24; p < 0.001）。在基线乳酸≥ 2 mmol/L的826例患者中，可获得足够的数据来计算第1天和第2天最大水平之间的差异（血清乳酸水平）。在对SOFA评分、年龄、临床虚弱量表和性别进行多变量调整后，乳酸浓度随时间的下降与ICU死亡率呈负相关（aOR 0.60 95%CI 0.42-0.85; p = 0.004）。在患有COVID-19的重症监护老年患者中，乳酸及其动力学是预测结果的宝贵工具。试验注册号：NCT 04321265。在线版本包含补充材料，可通过10.1186/s13613-021-00911-8获得。
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. 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. 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). 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. The online version contains supplementary material available at 10.1186/s13613-021-00911-8.
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影响因子：
4.1
作者：
Vassiliou AG;Jahaj E;Ilias I;Markaki V;Malachias S;Vrettou C;Ischaki E;Mastora Z;Douka E;Keskinidou C;Tsipilis S;Vassiliadi DA;Kotanidou A;Dimopoulou I
通讯作者：
Dimopoulou I
影响因子：
8
作者：
Smorenberg A;Peters EJ;van Daele P;Nossent EJ;Muller M
通讯作者：
Muller M
影响因子：
38.9
作者：
Guidet, Bertrand;de Lange, Dylan W.;Flaatten, Hans
通讯作者：
Flaatten, Hans
影响因子：
2.9
作者：
Claudia, Gregoriano;Daniel, Koch;Philipp, Schuetz
通讯作者：
Philipp, Schuetz
DOI：
10.4103/ijmr.ijmr_2890_20
发表时间：
2020
期刊：
The Indian journal of medical research
影响因子：
--
作者：
Kayina CA;Haritha D;Soni L;Behera S;Nair PR;Gouri M;Girish K;Deeparaj L;Maitra S;Anand RK;Ray BR;Baidya DK;Subramaniam R
通讯作者：
Subramaniam R