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Difference between elderly and non-elderly patients in using serum lactate level to predict mortality caused by sepsis in the emergency department.

Abstract Elderly people are more susceptible to sepsis and experience more comorbidities and complications than young adults. Serum lactate is a useful biomarker to predict mortality in patients with sepsis. Lactate production is affected by the severity of sepsis, organ dysfunction, and adrenergic stimulation. Whether the predictive ability of serum lactate will be different between non-elderly and elderly patients is unknown.A retrospective cohort study was conducted to compare the prognostic value of hyperlactatemia in predicting the mortality between elderly (≥65 years) and non-elderly (<65 years) patients with sepsis.This is a single-center retrospective observational cohort study conducted from January 2007 to December 2013 in southern Taiwan. All patients with sepsis, who used antibiotics, with blood culture collected, and with available serum lactate levels in the emergency department, were included in the analysis. We evaluated the difference in serum lactate level between the elderly and non-elderly septic patients by using multiple regression models.A total of 7087 patients were enrolled in the study. Elderly and non-elderly patients accounted for 62.3% (4414) and 40.2% (2673) of all patients, respectively. Statistically significant difference of serum lactate levels was not observed between elderly and non-elderly survivors (2.9 vs 3.0 mmol/L; P = .57); however, elderly patients had lower lactate levels than those within the 28-day in-hospital mortality (5.5 vs 6.6 mmol/L, P < .01). Multiple logistic regression revealed higher adjusted mortality risk in elderly and non-elderly patients with lactate levels of ≥4.0 mmol/L (odds ratio [OR], 4.98 and 5.82; P < .01, respectively), and lactate level between 2 and 4 mmol/L (OR, 1.57 and 1.99; P < .01, respectively) compared to that in the reference group with lactate levels of <2.0 mmol/L in each group. In receiver operating characteristic curve analysis, sensitivity rates for predicting mortality were 0.80 and 0.77 for non-elderly and elderly patients, respectively, by using serum lactate levels higher than 2.0 mmol/L.Septic elderly non-survivors had 1 mmol/L lower serum lactate level than those of the non-elderly non-survivors. Lactate >2 mmol/L still could provide enough sensitivity in predicting sepsis mortality in elder patients.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29595662
OWN - NLM
STAT- MEDLINE
DCOM- 20180411
LR  - 20180411
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 13
DP  - 2018 Mar
TI  - Difference between elderly and non-elderly patients in using serum lactate level 
      to predict mortality caused by sepsis in the emergency department.
PG  - e0209
LID - 10.1097/MD.0000000000010209 [doi]
AB  - Elderly people are more susceptible to sepsis and experience more comorbidities
      and complications than young adults. Serum lactate is a useful biomarker to
      predict mortality in patients with sepsis. Lactate production is affected by the 
      severity of sepsis, organ dysfunction, and adrenergic stimulation. Whether the
      predictive ability of serum lactate will be different between non-elderly and
      elderly patients is unknown.A retrospective cohort study was conducted to compare
      the prognostic value of hyperlactatemia in predicting the mortality between
      elderly (&gt;/=65 years) and non-elderly (&lt;65 years) patients with sepsis.This is a 
      single-center retrospective observational cohort study conducted from January
      2007 to December 2013 in southern Taiwan. All patients with sepsis, who used
      antibiotics, with blood culture collected, and with available serum lactate
      levels in the emergency department, were included in the analysis. We evaluated
      the difference in serum lactate level between the elderly and non-elderly septic 
      patients by using multiple regression models.A total of 7087 patients were
      enrolled in the study. Elderly and non-elderly patients accounted for 62.3%
      (4414) and 40.2% (2673) of all patients, respectively. Statistically significant 
      difference of serum lactate levels was not observed between elderly and
      non-elderly survivors (2.9 vs 3.0 mmol/L; P = .57); however, elderly patients had
      lower lactate levels than those within the 28-day in-hospital mortality (5.5 vs
      6.6 mmol/L, P &lt; .01). Multiple logistic regression revealed higher adjusted
      mortality risk in elderly and non-elderly patients with lactate levels of &gt;/=4.0 
      mmol/L (odds ratio [OR], 4.98 and 5.82; P &lt; .01, respectively), and lactate level
      between 2 and 4 mmol/L (OR, 1.57 and 1.99; P &lt; .01, respectively) compared to
      that in the reference group with lactate levels of &lt;2.0 mmol/L in each group. In 
      receiver operating characteristic curve analysis, sensitivity rates for
      predicting mortality were 0.80 and 0.77 for non-elderly and elderly patients,
      respectively, by using serum lactate levels higher than 2.0 mmol/L.Septic elderly
      non-survivors had 1 mmol/L lower serum lactate level than those of the
      non-elderly non-survivors. Lactate &gt;2 mmol/L still could provide enough
      sensitivity in predicting sepsis mortality in elder patients.
FAU - Cheng, Hsien-Hung
AU  - Cheng HH
FAU - Chen, Fu-Cheng
AU  - Chen FC
AD  - Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang
      Gung University College of Medicine.
FAU - Change, Meng-Wei
AU  - Change MW
AD  - Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang
      Gung University College of Medicine.
FAU - Kung, Chia-Te
AU  - Kung CT
AD  - Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang
      Gung University College of Medicine.
FAU - Cheng, Chi-Yung
AU  - Cheng CY
AD  - Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang
      Gung University College of Medicine.
FAU - Tsai, Tsung-Cheng
AU  - Tsai TC
AD  - Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang
      Gung University College of Medicine.
FAU - Hsiao, Sheng-Yuan
AU  - Hsiao SY
AD  - Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang
      Gung University College of Medicine.
FAU - Su, Chih-Min
AU  - Su CM
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Biomarkers)
RN  - 33X04XA5AT (Lactic Acid)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Biomarkers
MH  - Blood Culture
MH  - Comorbidity
MH  - Emergency Service, Hospital/*statistics &amp; numerical data
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Lactic Acid/*blood
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Prognosis
MH  - ROC Curve
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sepsis/*blood/drug therapy/*mortality
MH  - Severity of Illness Index
MH  - Taiwan
EDAT- 2018/03/30 06:00
MHDA- 2018/04/12 06:00
CRDT- 2018/03/30 06:00
PHST- 2018/03/30 06:00 [entrez]
PHST- 2018/03/30 06:00 [pubmed]
PHST- 2018/04/12 06:00 [medline]
AID - 10.1097/MD.0000000000010209 [doi]
AID - 00005792-201803300-00035 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Mar;97(13):e0209. doi: 10.1097/MD.0000000000010209.