Department of Emergency Medicine, Samsun University, Faculty of Medicine, Samsun, Turkey.
Department of Emergency Medicine, Samsun Education and Research Hospital, Samsun, Turkey.
Am J Emerg Med. 2023 Apr;66:45-52. doi: 10.1016/j.ajem.2023.01.019. Epub 2023 Jan 11.
In this study, we aimed to investigate the relationship between blood lactate levels and lactate kinetics (lactate clearance and Δ lactate) for predicting mortality in patients with COVID-19 admitted to the emergency department.
This study was performed as a retrospective study that included patients admitted to the emergency department between March 1st, 2020, and January 1st, 2022. Lactate levels were recorded at the first admission (0 h lactate) and the highest blood lactate levels in the first 24 h of follow-up (2nd highest lactate). Lactate kinetics were calculated. Clinical severity was determined according to the quick COVID Severity Index (qCSI).
300 patients were included in the study. Lactate levels at admission were similar in groups with or without mortality, but 2nd highest lactate levels were found to be significantly higher in the group with mortality (p < 0.001). Lactate clearance and ∆ lactate levels were also found to be lower in the mortality group (p < 0.001). Lactate kinetics in patients in the clinically low severity group were lower in the mortality group (p = 0.02 and p = 0.039, respectively). In the low-intermediate and high-intermediate groups, 0-h lactate and 2nd highest lactate levels were found to be higher in the mortality group, and lactate kinetics were similar in the groups with and without mortality. In the group with high clinical severity, 2nd highest lactate levels were found to be higher in the group with mortality (p = 0.010). Lactate kinetics were also found to be significantly lower in the mortality group (p < 0.001). In the high qCSI group, based on ROC analysis, the AUC for 2nd highest lactate levels predicting mortality was 0.642 (95% CI: 0.548-0.728). The optimal cut-off value for mortality was greater than >2.4 mmol/L (60.6% sensitivity, 67.4% specificity). The AUC for lactate clearance was 0.748 (95% CI: 0.659-0.824). The lactate clearance cut-off value was ≤ -177.78% (49.3% sensitivity, 100% specificity). The AUC for ∆ lactate was 0.707 (95% CI: 0.616-0.787). The optimal ∆ lactate cut-off was ≤ -2 mmol/L (45.1% sensitivity, 93.5% specificity).
In COVID-19, 2nd highest blood lactate and lactate kinetics were found to be prognostic indicators of the disease. High 2nd highest lactate levels and low lactate kinetics in patients with high clinical severity were guiding physicians regarding the outcome of the disease.
本研究旨在探讨 COVID-19 患者入院时血乳酸水平和乳酸动力学（乳酸清除率和Δ乳酸）与死亡率之间的关系。
本研究为回顾性研究，纳入 2020 年 3 月 1 日至 2022 年 1 月 1 日期间收入急诊科的患者。记录患者入院时（0 小时乳酸）和随访 24 小时内的最高血乳酸水平（第 2 高乳酸）。计算乳酸动力学。根据快速 COVID 严重指数（qCSI）确定临床严重程度。
共纳入 300 例患者。入院时的乳酸水平在有或无死亡的组之间相似，但死亡组的第 2 高乳酸水平明显更高（p < 0.001）。死亡组的乳酸清除率和Δ乳酸水平也较低（p < 0.001）。临床低严重程度组的患者，死亡率组的乳酸动力学较低（p = 0.02 和 p = 0.039）。在低中度和高中度组中，死亡率组的 0 小时乳酸和第 2 高乳酸水平较高，而有和无死亡的组之间的乳酸动力学相似。在临床严重程度高的组中，死亡率组的第 2 高乳酸水平较高（p = 0.010）。乳酸动力学也明显较低（p < 0.001）。在高 qCSI 组中，基于 ROC 分析，第 2 高乳酸水平预测死亡率的 AUC 为 0.642（95%CI：0.548-0.728）。死亡的最佳截断值大于>2.4mmol/L（60.6%灵敏度，67.4%特异性）。乳酸清除率的 AUC 为 0.748（95%CI：0.659-0.824）。乳酸清除率的截断值为≤-177.78%（49.3%灵敏度，100%特异性）。Δ乳酸的 AUC 为 0.707（95%CI：0.616-0.787）。最佳Δ乳酸截断值为≤-2mmol/L（45.1%灵敏度，93.5%特异性）。
在 COVID-19 中，第 2 高血乳酸和乳酸动力学是疾病预后的指标。高临床严重程度患者的第 2 高乳酸水平和低乳酸动力学提示疾病结局。
