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...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
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Springer Science and Business Media LLC
2022
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| Online Access: | https://hdl.handle.net/1721.1/138827 |
| _version_ | 1826202010711490560 |
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| author | Sauer, Christopher M. Gómez, Josep Botella, Manuel Ruiz Ziehr, David R. Oldham, William M. Gavidia, Giovana Rodríguez, Alejandro Elbers, Paul Girbes, Armand Bodi, Maria Celi, Leo Anthony |
| author2 | Harvard--MIT Program in Health Sciences and Technology. Laboratory for Computational Physiology |
| author_facet | Harvard--MIT Program in Health Sciences and Technology. Laboratory for Computational Physiology Sauer, Christopher M. Gómez, Josep Botella, Manuel Ruiz Ziehr, David R. Oldham, William M. Gavidia, Giovana Rodríguez, Alejandro Elbers, Paul Girbes, Armand Bodi, Maria Celi, Leo Anthony |
| author_sort | Sauer, Christopher M. |
| collection | MIT |
| 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. |
| first_indexed | 2024-09-23T12:00:27Z |
| format | Article |
| id | mit-1721.1/138827 |
| institution | Massachusetts Institute of Technology |
| last_indexed | 2024-09-23T12:00:27Z |
| publishDate | 2022 |
| publisher | Springer Science and Business Media LLC |
| record_format | dspace |
| spelling | mit-1721.1/1388272024-06-07T20:17:05Z Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts Sauer, Christopher M. Gómez, Josep Botella, Manuel Ruiz Ziehr, David R. Oldham, William M. Gavidia, Giovana Rodríguez, Alejandro Elbers, Paul Girbes, Armand Bodi, Maria Celi, Leo Anthony Harvard--MIT Program in Health Sciences and Technology. Laboratory for Computational Physiology Massachusetts Institute of Technology. Institute for Medical Engineering & Science 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. 2022-01-05T18:06:47Z 2022-01-05T18:06:47Z 2021-10-08 Article http://purl.org/eprint/type/JournalArticle 2045-2322 https://hdl.handle.net/1721.1/138827 Sauer, C.M., Gómez, J., Botella, M.R. et al. Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts. Sci Rep 11, 20076 (2021) 10.1038/s41598-021-99581-6 Creative Commons Attribution 4.0 International license https://creativecommons.org/licenses/by/4.0/ application/pdf Springer Science and Business Media LLC Nature |
| spellingShingle | Sauer, Christopher M. Gómez, Josep Botella, Manuel Ruiz Ziehr, David R. Oldham, William M. Gavidia, Giovana Rodríguez, Alejandro Elbers, Paul Girbes, Armand Bodi, Maria Celi, Leo Anthony Understanding critically ill sepsis patients with normal serum lactate levels: results from U.S. and European ICU cohorts |
| title | 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_short | 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 |
| url | https://hdl.handle.net/1721.1/138827 |
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