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Distribution of maximum serum lactate values on day 1 (= day of ICU-admission), [mmol/L]

Distribution of maximum serum lactate values on day 1 (= day of ICU-admission), [mmol/L]

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Purpose: 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. Methods: This prospective international observation study (The COVIP st...

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Purpose: 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. Methods: This prospective international observation study (The COVIP study...
Article
Full-text available
Purpose: 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. Methods: This prospective international observation study (The COVIP study...

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... Prolonged tissue hypoxia seen in patients with COVID-19 plays an important role in the development of subsequent organ dysfunction and mortality. A number of studies have reported the correlation between tissue hypoxia, lactate levels, and mortality among critically ill patients with COVID-19 [31,32]. We should therefore aim for the early implementation of ECMO before a patient's lactate level becomes elevated. ...
Article
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Background In Poland, the clinical characteristics and outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation (ECMO) remain unknown. This study aimed to answer these unknowns by analyzing data collected from high-volume ECMO centers willing to participate in this project. Methods This retrospective, multicenter cohort study was completed between March 1, 2020, and May 31, 2021 (15 months). Data from all patients treated with ECMO for COVID-19 were analyzed. Pre-ECMO laboratory and treatment data were compared between non-survivors and survivors. Independent predictors for death in the intensive care unit (ICU) were identified. Results There were 171 patients admitted to participating centers requiring ECMO for refractory hypoxemia due to COVID-19 during the defined time period. A total of 158 patients (mean age: 46.3 ± 9.8 years) were analyzed, and 13 patients were still requiring ECMO at the end of the observation period. Most patients (88%) were treated after October 1, 2020, 77.8% were transferred to ECMO centers from another facility, and 31% were transferred on extracorporeal life support. The mean duration of ECMO therapy was 18.0 ± 13.5 days. The crude ICU mortality rate was 74.1%. In the group of 41 survivors, 37 patients were successfully weaned from ECMO support and four patients underwent a successful lung transplant. In-hospital death was independently associated with pre-ECMO lactate level (OR 2.10 per 1 mmol/L, p = 0.017) and BMI (OR 1.47 per 5 kg/m ² , p = 0.050). Conclusions The ICU mortality rate among patients requiring ECMO for COVID-19 in Poland was high. In-hospital death was independently associated with increased pre-ECMO lactate levels and BMI.
... Die klinische Manifestation von COVID-19 reicht von leichten und unspezifischen Symptomen der oberen Atemwege bis hin zu schweren Verläufen, die eine invasive mechanische Beatmung erfordern und ein Multiorganversagen verursachen können [4]. Die Mortalität reicht je nach Risikokollektiv von 1 % bei jungen gesunden Patienten bis zu 49 % bei älteren und komorbiden Patienten [5,6]. Komorbiditäten wie Bluthochdruck, Diabetes, chronische Niereninsuffizienz, kardiovaskuläre und pulmonale Vorerkran- ...
... Die Laborwerte (. Tab. 3) zeigten initial ein leicht erhöhtes hs-cTnT ("highsensitive cardiac troponin T") mit 41 (15,5) pg/ml und ein ebenfalls erhöhtes NT-proBNP ("N-terminales pro brain natriuretic peptide") von 620 (268, Die Auswirkung der zugrunde liegenden immunsuppressiven medikamentösen Therapie auf den Verlauf der COVID-19-Infektion bleibt umstritten. In-vitro-Daten deuten z. ...
Article
Background The pandemic caused by SARS-CoV‑2 (severe acute respiratory syndrome coronavirus type 2) has led to hospitalizations and increased mortality worldwide. With potentially high prevalence and severity of COVID-19 in cardiac transplantation, there is a great need to generate data in this at-risk cohort.Objective We report here our experience with COVID-19 (coronavirus disease 2019) in heart transplant recipients at a German transplantation center longitudinally over the previous pandemic waves and place it in context to published experiences of other centers.Material and methodsAll adult patients who had received a heart transplant at our center and had confirmed COVID-19 infection (n = 12) were included and retrospectively characterized.ResultsThe mean age was 61.5 (49–63) years, and the majority were male (83%). Comorbidities such as diabetes (42%), arterial hypertension (43%), and chronic renal failure (67%) were found. Passive immunization (convalescent plasma/monoclonal antibodies) was performed in 50%. Oxygen administration was required in 33% of patients; only one patient required noninvasive ventilation (8%), and no patient required invasive ventilation or mechanical cardiovascular support (ECMO). No new cardiovascular or thromboembolic events were found.Conclusion We could longitudinally not detect severe courses or increased mortality of COVID-19 in heart transplant patients. Prospective studies are needed to make better prognostic estimates of COVID-19 in (heart) transplant patients in the future.
... 61 Another study involving 2860 Covid-19 patients related high serum lactate levels to the need for intensive care units (ICUs) and mortality, with patients reaching 150% of increasing lactate levels compared to normal levels. 62 Our data showed 76% elevated lactate levels in the severe patient's group. However, it is worth mentioning that our samples were collected earlier to the individual's hospitalization, i.e., the first search for help in the medical care system. ...
Article
The coronavirus disease 2019 (Covid-19), which caused respiratory problems in many patients worldwide, led to more than 5 million deaths by the end of 2021. Experienced symptoms vary from mild to severe illness. Understanding the infection severity to reach a better prognosis could be useful to the clinics, and one study area to fulfill one piece of this biological puzzle is metabolomics. The metabolite profile and/or levels being monitored can help predict phenotype properties. Therefore, this study evaluated plasma metabolomes of 110 individual samples, 57 from control patients and 53 from recent positive cases of Covid-19 (IgM 98% reagent), representing mild to severe symptoms, before any clinical intervention. Polar metabolites from plasma samples were analyzed by quantitative 1 H NMR. Glycerol, 3-aminoisobutyrate, formate, and glucuronate levels showed alterations in Covid-19 patients compared to those in the control group (Tukey's HSD p-value cutoff = 0.05), affecting the lactate, phenylalanine, tyrosine, and tryptophan biosynthesis and D-glutamine, D-glutamate, and glycerolipid metabolisms. These metabolic alterations show that SARS-CoV-2 infection led to disturbance in the energetic system, supporting the viral replication and corroborating with the severe clinical conditions of patients. Six polar metabolites (glycerol, acetate, 3-aminoisobutyrate, formate, glucuronate, and lactate) were revealed by PLS-DA and predicted by ROC curves and ANOVA to be potential prognostic metabolite panels for Covid-19 and considered clinically relevant for predicting infection severity due to their straight roles in the lipid and energy metabolism. Thus, metabolomics from samples of Covid-19 patients is a powerful tool for a better understanding of the disease mechanism of action and metabolic consequences of the infection in the human body and may corroborate allowing clinicians to intervene quickly according to the needs of Covid-19 patients.
... The value of serum lactate, a parameter of physiological stress and anaerobic metabolism may be recommended in future guidelines to appreciate the COVID-19 severity and the progression of disease. But until now, the value of serum lactate in predicting a severe course in COVID-19 in adults and children is still unclear [22,23]. ...
Article
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In the case of SARS-CoV-2 infection, children seem to be less affected than adults, but data regarding epidemiologic characteristics and biochemical values are poor and essentially based on limited case series. The aim of our study is to highlight the predictive value of some biochemical markers at hospitalization, for the correct classification of the patient in the form of disease. Methods: We performed an analytical retrospective study on 82 pediatric patients diagnosed with COVID-19 in the emergency department, with moderate or severe form of disease, and treated in our tertiary hospital. We analyzed the epidemiologic characteristics, symptomatology and biochemical values and compare the data according to the form of disease. Results: The mean age at admission was 4.5 years (median 1 year) and the masculine/feminine ratio was 1.5. Comparing the data between the two groups of patients (42 severe/40 moderate), we observed that the severe form presented with a lower pH at admission (p = 0.02), hyperglycemia (p = 0.01), increased values of transaminases (p = 0.01 and 0.02) and hypoproteinemia (p = 0.01). Also, the severe form was statistically significantly associated with comorbidities, acute respiratory distress, rising of the inflammatory markers during hospitalization. Hyperlactatemia (Lactate > 1.5 mmol/L) was significantly associated with the age under one year (p < 0.001). Mortality rate was 9.75% and the median age at death was 3 months. Univariate logistic regression model shows that the presence of anemia increased the probability of death 88 times, comorbidities 23.3 times and ketoacidosis 16.4 times. Conclusions: Metabolic acidosis, hyperlactatemia, hyperglycemia, modified hepatic values and hypoproteinemia are biochemical markers associated with the severe form of disease in SARS-CoV-2 infection in children. Presence of anemia, comorbidities and ketoacidosis are important risk factors for death of pediatric patients with SARS-CoV-2 infection.
... age and comorbidities) factors which predict mortality in combination with the SOFA score in patients hospitalized for a restricted list of potentially severe infections (pneumoniae, necrotizing dermohypodermitis, acute pyelonephritis, acute peritonitis, endocarditis, central venous catheter infection, meningitis, and acute osteoarthritis). Recently, other authors have shown the predictive value of age for sepsis-related mortality [69][70][71], but none demonstrated an equivalence between "modifiable" and "non-modifiable" factors using a scoring-point system of mortality prediction. us, it is interesting that in terms of mortality prediction and in this specific population, a lactatemia of ≥2 mmol/L is barely equivalent to an age of Critical Care Research and Practice ≥40 years or a Charlson's comorbidity score of ≥2 (Table 3). ...
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Objective: Our primary aim was to assess selected metabolic dysfunction parameters, both independently and as a complement to the SOFA score, as predictors of short-term mortality in patients with infection admitted to the intensive care unit (ICU). Methods: We retrospectively enrolled all consecutive adult patients admitted to the eight ICUs of Lille University Hospital, between January 2015 and September 2016, with suspected or confirmed infection. We selected seven routinely measured biological and clinical parameters of metabolic dysfunction (maximal arterial lactatemia, minimal and maximal temperature, minimal and maximal glycaemia, cholesterolemia, and triglyceridemia), in addition to age and the Charlson's comorbidity score. All parameters and SOFA scores were recorded within 24 h of admission. Results: We included 956 patients with infection, among which 295 (30.9%) died within 90 days. Among the seven metabolic parameters investigated, only maximal lactatemia was associated with higher risk of 90-day hospital mortality in SOFA-adjusted analyses (SOFA-adjusted OR, 1.17; 95%CI, 1.10 to 1.25; p < 0.001). Age and the Charlson's comorbidity score were also statistically associated with a poor prognosis in SOFA-adjusted analyses. We were thus able to develop a metabolic failure, age, and comorbidity assessment (MACA) score based on scales of lactatemia, age, and the Charlson's score, intended for use in combination with the SOFA score. Conclusions: The maximal lactatemia level within 24 h of ICU admission is the best predictor of short-term mortality among seven measures of metabolic dysfunction. Our combined "SOFA + MACA" score could facilitate early detection of patients likely to develop severe infections. Its accuracy requires further evaluation.
... Univariate and multivariable Cox analysis of factors associated with day-90 death in the 780 patients with BSI is shown in Additional file 1: Table S3. Age, frailty scale [21], SOFA score the day of BSI, co-infection at admission, antibiotic and tocilizumab use during period at risk for BSI were associated with increased risk of day-90 death. ...
Article
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Background Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors and outcome of BSI in critically ill coronavirus infectious disease-19 (COVID-19) patients. Patients and methods We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU study) that included 4010 COVID-19 ICU patients. For the present analysis, only those with data regarding primary outcome (death within 90 days from admission) or BSI status were included. Risk factors for BSI were analyzed using Fine and Gray competing risk model. Then, for outcome comparison, 537 BSI-patients were matched with 537 controls using propensity score matching. Results Among 4010 included patients, 780 (19.5%) acquired a total of 1066 BSI (10.3 BSI per 1000 patients days at risk) of whom 92% were acquired in the ICU. Higher SAPS II, male gender, longer time from hospital to ICU admission and antiviral drug before admission were independently associated with an increased risk of BSI, and interestingly, this risk decreased over time. BSI was independently associated with a shorter time to death in the overall population (adjusted hazard ratio (aHR) 1.28, 95% CI 1.05–1.56) and, in the propensity score matched data set, patients with BSI had a higher mortality rate (39% vs 33% p = 0.036). BSI accounted for 3.6% of the death of the overall population. Conclusion COVID-19 ICU patients have a high risk of BSI, especially early after ICU admission, risk that increases with severity but not with corticosteroids use. BSI is associated with an increased mortality rate.
... A total number of 2,659 studies were initially identified by our search criteria, 1,112 of which were excluded for duplication among the two databases, whilst 1,528 were also excluded because they failed to report lactate values. Nineteen studies, totalling 6,459 patients, were finally included in our systematic review [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram is shown in Figure 1, whist the PRISMA checklist is available as Supplementary File 1. ...
... In two of the studies which described the risk of death in patients with blood hyperlactatemia (cut-off value set at blood lactate concentration >2 mmol/L) [5,6], the risk of death was found to be higher in COVID-19 patients with elevated blood lactate values (Table 1). Eleven additional studies compared blood lactate values in COVID-19 survivors vs. non-survivors (2,744 total patients, 671 (24.5%) died) [7-11, 13-17, 20]. ...
Article
Full-text available
Coronavirus disease 2019 (COVID-19) is an infectious respiratory condition sustained by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which manifests prevalently as mild to moderate respiratory tract infection. Nevertheless, in a number of cases the clinical course may deteriorate, with onset of end organ injury, systemic dysfunction, thrombosis and ischemia. Given the clinical picture, baseline assessment and serial monitoring of blood lactate concentration may be conceivably useful in COVID-19. We hence performed a systematic literature review to explore the possible association between increased blood lactate levels, disease severity and mortality in COVID-19 patients, including comparison of lactate values between COVID-19 and non-COVID-19 patients. We carried out an electronic search in Medline and Scopus, using the keywords “COVID-19” OR “SARS-CoV-2” AND “lactate” OR “lactic acid” OR “hyperlactatemia”, between 2019 and present time (i.e. October 10, 2021), which allowed to identify 19 studies, totalling 6,459 patients. Overall, we found that COVID-19 patients with worse outcome tend to display higher lactate values than those with better outcome, although most COVID-19 patients in the studies included in our analysis did not have sustained baseline hyperlactatemia. Substantially elevated lactate values were neither consistently present in all COVID-19 patients who developed unfavourable clinical outcomes. These findings suggest that blood lactate monitoring upon admission and throughout hospitalization may be useful for early identification of higher risk of unfavourable COVID-19 illness progression, though therapeutic decisions based on using conventional hyperlactatemia cut-off values (i.e., 2.0mmol/L) upon first evaluation may be inappropriate in patients with SARS-CoV-2 infection.
... These patients were significantly older (75 years (72-78) versus 75 years (72-79), p = 0.004). In the group of patients with MELD-XI ≥ 12, the BMI was higher (27 kg/m² (25-31) versus 28 kg/m² (25)(26)(27)(28)(29)(30)(31), p = 0.0026). Also, the percentages of patients with comorbidities like diabetes, chronic renal failure, and arterial hypertension were higher in the group of patients with a MELD-XI ≥ 12. On admission to ICU, the SOFA score was significantly higher in the group of high MELD-XI (4 (3-7) versus 8 (6-10), p < 0.001). ...
... Here, an elevated baseline serum lactate (≥2.0 mmol/L) was significantly associated with ICU-and 3-month-mortality. A decreasing lactate concentration in the first 24 hours was inversely associated with ICU-mortality after multivariate adjustment [28] All these methods (MELD-XI score, the SOFA score, and the lactate values) share a significant limitation: They mainly indicate a deterioration when manifest organ dysfunctions are already present [29]. Theoretically, it would be better to detect declining organ function before manifest organ dysfunction occurs [30]. ...
Article
PURPOSECritically ill elderly patients who suffer from Sars-CoV-2 disease are at high risk for organ failure. The modified MELD-XI score has not been evaluated for outcome prediction in these most vulnerable patients.METHODS The Corona Virus disease (COVID19) in Very Elderly Intensive Care Patients study (COVIP, NCT04321265) prospectively recruited patients on intensive care units (ICU), who were = 70 years. Data were collected from March 2020 to February 2021. The MELD-XI score was calculated using the highest serum bilirubin and creatinine on ICU admission. Univariate and multivariable logistic regression analyses were performed to assess associations between the MELD-XI score and mortality. The primary outcome was 30-day-mortality, the secondary outcomes were ICU- and 3-month-mortality.RESULTSIn total, data from 2,993 patients were analyzed. Most patients had a MELD-XI <12 on admission (76%). The patients with MELD-XI = 12 had a significantly higher 30-day-, ICU- and 3-month-mortality (44%vs 64%, and 42%vs. 59%, and 57%vs. 76%, p < 0.001). After adjustment for multiple confounders, MELD-XI = 12 remained significantly associated with 30-day- (aOR 1.572, CI 1.268-1.949, p < 0.001), ICU-, and 3-month-mortality.CONCLUSION In critically ill elderly intensive care patients with COVID-19, the MELD-XI score constitutes a valuable tool for an early outcome prediction.
... However, the similarity has been a brake on the decision of an adequate treatment, which is based on the inflammatory blockade using high doses of corticosteroids. [16], [17] The presence of cardiac damage seems to be something prevalent even considering young patients who developed CSF with shock [3], [18]- [21]. New-onset biventricular failure and vasoplegia progressed to shock with multiorgan dysfunction. ...
... In the multivariable analysis, the maximum lactate concentration on day 1 was independently associated with ICU mortality (aOR 1. ). Ten patients with MIS-A presented with Kawasaki disease [3], [18], [22]. According to the above, there is a rarity on the subject of "chronic inflammation" or "inflammatory shock" in COVID-19 patients, as most data refer to the disease in the acute phase. ...
Preprint
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Background: COVID-19 brought challenges that did not end after a two-year pandemic. From more straightforward changes in habits to studying to understand the enigmatic parasite host relationship, we can better manage the patient infected with Sars-CoV-2 even with a vaccine full of doubts and antivirals that do not correctly cover the viral period. Sars-CoV-2 brought the chronic inflammation now called "The Long COVID-19 Syn-drome" (LCS), something still little talked about, but we already see deaths due to non-identification of this inflammatory syndrome that can lead to shock. Theory: LCS Shock is due to a long period of metabolic stress, reflecting the shift from inflammation to oxi-dative stress and innate immunity, and does not respond to antimicrobials, as its main component is inflammatory, although there may be conjoined bacterial translocation. Thus, we are losing patients to a new syndrome confused with sepsis and septic shock. While septic shock (SS) responds to antimicrobials, Inflammatory Shock (ISc) does not respond to antimicrobials alone, requiring high doses of corticosteroids. Review: This study shows that we need to differentiate SS and ISC, as the treatment is different. The review shows that Lactate, LDH and the presence of new/recent cardiac changes and brad-ycardia in the face of a status where there should be tachycardia as the usual response can differ ISC from SS. Maybe the main responsible for high LDH is Warburg Effect. Conclusion: we have a dilemma that requires clinical studies that routinely match high doses of corticosteroids (until there is something better to be done) and bring laboratory and imaging differences to diagnose SS vs ISc better.
Article
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The aim of this study was to evaluate the prognostic value of the Lactate to Albumin (L/A) ratio compared to that of lactate and lactate clearance in predicting outcomes in patients with septic shock. This was a multi-center observational study of adult patients with septic shock, who admitted to intensive care units (ICUs) at Shohada and Imam Reza Hospitals, Tabriz, Iran, between Sept 2018 and Jan 2021. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to explore associations of the L/A ratio, lactate and lactate clearance on the primary (mortality) and secondary outcomes [ICU length of stay (LOS), duration of mechanical ventilation (MV), need of renal replacement therapy (RRT) and duration of using vasopressors] at baseline, 6 h and 24 h of septic shock recognition. Best performing predictive value for mortality were related to lactate clearance at 24 h, L/A ratio at 6 h and lactate levels at 24 h with (AUC 0.963, 95% CI 0.918–0.987, P < 0.001), (AUC 0.917, 95% CI 0.861–0.956, P < 0.001), and (AUC 0.904, 95% CI 0.845–0.946, P < 0.001), respectively. Generally, the lactate clearance at 24 h had better prognostic performance for mortality and duration of using vasopressor. However, the L/A ratio had better prognostic performance than serum lactate and lactate clearance for RRT, ICU LOS and MV duration.