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Lactate improves SAPS 3 prognostication

Andersson, P LU and Frigyesi, A. LU (2017) In Acta Anaesthesiologica Scandinavica
Abstract

Introduction: Lactate concentration is known to be a strong predictor of mortality, but is not included in any of the major intensive care scorings systems such as the Simplified Acute Physiology Score (SAPS 3). The objective of this study was to investigate the prognostic value of lactate concentration when combined with SAPS 3. Materials and methods: In the period of 2008 to June 2017 the general intensive care unit at Skåne University Hospital in Lund, Sweden had 5141 first-time admissions. Of these, 3039 patients had lactate concentrations analysed within 1 h of admission. Results: As expected, lactate concentration was found to be strongly related to 30-day mortality. Lactate concentration was found to be a SAPS 3 independent... (More)

Introduction: Lactate concentration is known to be a strong predictor of mortality, but is not included in any of the major intensive care scorings systems such as the Simplified Acute Physiology Score (SAPS 3). The objective of this study was to investigate the prognostic value of lactate concentration when combined with SAPS 3. Materials and methods: In the period of 2008 to June 2017 the general intensive care unit at Skåne University Hospital in Lund, Sweden had 5141 first-time admissions. Of these, 3039 patients had lactate concentrations analysed within 1 h of admission. Results: As expected, lactate concentration was found to be strongly related to 30-day mortality. Lactate concentration was found to be a SAPS 3 independent predictor of mortality (odds ratio 1.08, 95% confidence interval 1.05-1.11, P < 0.001), but did not improve the area under the receiver operating characteristic curve (AUC) (AUC 78.9% vs. 78.7%, P = 0.053). However, we found that lactate added prognostic value to SAPS 3 for patients with cardiac arrest (AUC 79.6% vs. 76.4%, P = 0.0082) and sepsis (AUC 75.1% vs. 72.7%, P = 0.033). Conclusion: Even compared to our current prognostication model, SAPS 3, lactate concentration was found to be an independent predictor for all diagnoses, cardiac arrest and sepsis. The addition of lactate concentration level improved the AUC for cardiac arrest and sepsis, but not for all diagnoses.

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organization
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Contribution to journal
publication status
epub
subject
in
Acta Anaesthesiologica Scandinavica
publisher
Wiley-Blackwell
external identifiers
  • scopus:85033583510
ISSN
0001-5172
DOI
10.1111/aas.13033
language
English
LU publication?
yes
id
89f69dc3-4889-4b60-bed3-6daaab4329d7
date added to LUP
2017-12-12 16:03:48
date last changed
2018-01-07 12:28:33
@article{89f69dc3-4889-4b60-bed3-6daaab4329d7,
  abstract     = {<p>Introduction: Lactate concentration is known to be a strong predictor of mortality, but is not included in any of the major intensive care scorings systems such as the Simplified Acute Physiology Score (SAPS 3). The objective of this study was to investigate the prognostic value of lactate concentration when combined with SAPS 3. Materials and methods: In the period of 2008 to June 2017 the general intensive care unit at Skåne University Hospital in Lund, Sweden had 5141 first-time admissions. Of these, 3039 patients had lactate concentrations analysed within 1 h of admission. Results: As expected, lactate concentration was found to be strongly related to 30-day mortality. Lactate concentration was found to be a SAPS 3 independent predictor of mortality (odds ratio 1.08, 95% confidence interval 1.05-1.11, P &lt; 0.001), but did not improve the area under the receiver operating characteristic curve (AUC) (AUC 78.9% vs. 78.7%, P = 0.053). However, we found that lactate added prognostic value to SAPS 3 for patients with cardiac arrest (AUC 79.6% vs. 76.4%, P = 0.0082) and sepsis (AUC 75.1% vs. 72.7%, P = 0.033). Conclusion: Even compared to our current prognostication model, SAPS 3, lactate concentration was found to be an independent predictor for all diagnoses, cardiac arrest and sepsis. The addition of lactate concentration level improved the AUC for cardiac arrest and sepsis, but not for all diagnoses.</p>},
  author       = {Andersson, P and Frigyesi, A.},
  issn         = {0001-5172},
  language     = {eng},
  month        = {11},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Anaesthesiologica Scandinavica},
  title        = {Lactate improves SAPS 3 prognostication},
  url          = {http://dx.doi.org/10.1111/aas.13033},
  year         = {2017},
}