Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts

Abstract While serum lactate level is a predictor of poor clinical outcomes among critically ill patients with sepsis, many have normal serum lactate. A better understanding of this discordance may help differentiate sepsis phenotypes and offer clues to sepsis pathophysiology. Three intensive care u...

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Autores principales:	Christopher M. Sauer, Josep Gómez, Manuel Ruiz Botella, David R. Ziehr, William M. Oldham, Giovana Gavidia, Alejandro Rodríguez, Paul Elbers, Armand Girbes, Maria Bodi, Leo Anthony Celi
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/097b171bdf624845bedb641519c93f7b
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spelling	oai:doaj.org-article:097b171bdf624845bedb641519c93f7b2021-12-02T17:13:16ZUnderstanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts10.1038/s41598-021-99581-62045-2322https://doaj.org/article/097b171bdf624845bedb641519c93f7b2021-10-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-99581-6https://doaj.org/toc/2045-2322Abstract While serum lactate level is a predictor of poor clinical outcomes among critically ill patients with sepsis, many have normal serum lactate. A better understanding of this discordance may help differentiate sepsis phenotypes and offer clues to sepsis pathophysiology. Three intensive care unit datasets were utilized. Adult sepsis patients in the highest quartile of illness severity scores were identified. Logistic regression, random forests, and partial least square models were built for each data set. Features differentiating patients with normal/high serum lactate on day 1 were reported. To exclude that differences between the groups were due to potential confounding by pre-resuscitation hyperlactatemia, the analyses were repeated for day 2. Of 4861 patients included, 47% had normal lactate levels. Patients with normal serum lactate levels had lower 28-day mortality rates than those with high lactate levels (17% versus 40%) despite comparable physiologic phenotypes. While performance varied between datasets, logistic regression consistently performed best (area under the receiver operator curve 87–99%). The variables most strongly associated with normal serum lactate were serum bicarbonate, chloride, and pulmonary disease, while serum sodium, AST and liver disease were associated with high serum lactate. Future studies should confirm these findings and establish the underlying pathophysiological mechanisms, thus disentangling association and causation.Christopher M. SauerJosep GómezManuel Ruiz BotellaDavid R. ZiehrWilliam M. OldhamGiovana GavidiaAlejandro RodríguezPaul ElbersArmand GirbesMaria BodiLeo Anthony CeliNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Christopher M. Sauer Josep Gómez Manuel Ruiz Botella David R. Ziehr William M. Oldham Giovana Gavidia Alejandro Rodríguez Paul Elbers Armand Girbes Maria Bodi Leo Anthony Celi Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts
description	Abstract While serum lactate level is a predictor of poor clinical outcomes among critically ill patients with sepsis, many have normal serum lactate. A better understanding of this discordance may help differentiate sepsis phenotypes and offer clues to sepsis pathophysiology. Three intensive care unit datasets were utilized. Adult sepsis patients in the highest quartile of illness severity scores were identified. Logistic regression, random forests, and partial least square models were built for each data set. Features differentiating patients with normal/high serum lactate on day 1 were reported. To exclude that differences between the groups were due to potential confounding by pre-resuscitation hyperlactatemia, the analyses were repeated for day 2. Of 4861 patients included, 47% had normal lactate levels. Patients with normal serum lactate levels had lower 28-day mortality rates than those with high lactate levels (17% versus 40%) despite comparable physiologic phenotypes. While performance varied between datasets, logistic regression consistently performed best (area under the receiver operator curve 87–99%). The variables most strongly associated with normal serum lactate were serum bicarbonate, chloride, and pulmonary disease, while serum sodium, AST and liver disease were associated with high serum lactate. Future studies should confirm these findings and establish the underlying pathophysiological mechanisms, thus disentangling association and causation.
format	article
author	Christopher M. Sauer Josep Gómez Manuel Ruiz Botella David R. Ziehr William M. Oldham Giovana Gavidia Alejandro Rodríguez Paul Elbers Armand Girbes Maria Bodi Leo Anthony Celi
author_facet	Christopher M. Sauer Josep Gómez Manuel Ruiz Botella David R. Ziehr William M. Oldham Giovana Gavidia Alejandro Rodríguez Paul Elbers Armand Girbes Maria Bodi Leo Anthony Celi
author_sort	Christopher M. Sauer
title	Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts
title_short	Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts
title_full	Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts
title_fullStr	Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts
title_full_unstemmed	Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts
title_sort	understanding critically ill sepsis patients with normal serum lactate levels: results from u.s. and european icu cohorts
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/097b171bdf624845bedb641519c93f7b
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Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts

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