Impact on outcomes of measuring lactates prior to ICU in unselected heterogeneous critically ill patients: A propensity score analysis Article Swipe
Taro Tamakawa
,
Hiroshi Endoh
,
Natuo Kamimura
,
Kazuki Deuchi
,
Kei Nishiyama
·
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0277948
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pone.0277948
Background Elevated blood lactate levels were reported as effective predictors of clinical outcome and mortality in ICU. However, there have been no studies simply comparing the timing of measuring lactates before vs. after ICU admission. Methods A total of 19,226 patients with transfer time ≤ 24 hr were extracted from the Medical Information Mart for Intensive Care IV database (MIMIC-IV). After 1:1 propensity score matching, the patients were divided into two groups: measuring lactates within 3 hr before (BICU group, n = 4,755) and measuring lactate within 3 hr after ICU admission(AICU group, n = 4,755). The primary and secondary outcomes were hospital mortality, hospital 28-day mortality, ICU mortality, ICU length of stay (LOS), hospital LOS, and restricted mean survival time (RMST). Results Hospital, hospital 28-day, and ICU mortality were significantly higher in AICU group (7.0% vs.9.8%, 6.7% vs. 9.4%, and 4.6% vs.6.7%, respectively, p <0.001 for all) Hospital LOS and ICU LOS were significantly longer in AICU group (8.4 days vs. 9.0 days and 3.0 days vs. 3.5 days, respectively, p <0.001 for both). After adjustment for predefined covariates, a significant association between the timing of measuring lactate and hospital mortality was observed in inverse probability treatment weight (IPTW) multivariate regression, doubly robust multivariate regression, and multivariate regression models (OR, 0.96 [95%CI, 0.95-0.97], OR 0.52 [95%CI, 0.46-0.60], OR 0.66 [95%CI, 0.56-0.78], respectively, p<0.001 for all), indicating the timing as a significant risk-adjusted factor for lower hospital mortality. The difference (BICU-AICU) of RMST at 28- days after ICU admission was 0.531 days (95%CI, 0.002-1.059, p<0.05). Placement of A-line and PA-catheter, administration of intravenous antibiotics, and bolus fluid infusion during the first 24-hr in ICU were significantly more frequent and faster in the BICU vs AICU group (67.6% vs. 51.3% and 126min vs.197min for A-line, 19.6% vs.13.2% and 182min vs. 274min for PA-catheter, 77.5% vs.67.6% and 109min vs.168min for antibiotics, and 57.6% vs.51.6% and 224min vs.278min for bolus fluid infusion, respectively, p<0.001 for all). Additionally, a significant indirect effect was observed in frequency (0.19879 [95% CI, 0.14061-0.25697] p<0.001) and time (0.07714 [95% CI, 0.22600-0.13168], p<0.01) of A-line replacement, frequency of placement of PA-catheter (0.05614 [95% CI, 0.04088-0.07140], p<0.001) and frequency of bolus fluid infusion (0.02193 [95%CI, 0.00303-0.04083], p<0.05). Conclusions Measuring lactates within 3 hr prior to ICU might be associated with lower hospital mortality in unselected heterogeneous critically ill patients with transfer time to ICU ≤ 24hr, presumably due to more frequent and faster therapeutic interventions.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1371/journal.pone.0277948
- https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0277948&type=printable
- OA Status
- gold
- Cited By
- 1
- References
- 33
- Related Works
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- OpenAlex ID
- https://openalex.org/W4310149742
All OpenAlex metadata
Raw OpenAlex JSON
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https://openalex.org/W4310149742Canonical identifier for this work in OpenAlex
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https://doi.org/10.1371/journal.pone.0277948Digital Object Identifier
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Impact on outcomes of measuring lactates prior to ICU in unselected heterogeneous critically ill patients: A propensity score analysisWork title
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articleOpenAlex work type
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enPrimary language
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2022Year of publication
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2022-11-28Full publication date if available
- Authors
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Taro Tamakawa, Hiroshi Endoh, Natuo Kamimura, Kazuki Deuchi, Kei NishiyamaList of authors in order
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https://doi.org/10.1371/journal.pone.0277948Publisher landing page
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https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0277948&type=printableDirect link to full text PDF
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
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https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0277948&type=printableDirect OA link when available
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Propensity score matching, Critically ill, Medicine, Intensive care medicine, Critical illness, Internal medicineTop concepts (fields/topics) attached by OpenAlex
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10Other works algorithmically related by OpenAlex
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