Lactate Kinetics Reflect Organ Dysfunction and Are Associated with Adverse Outcomes in Intensive Care Unit Patients with COVID-19 Pneumonia: Preliminary Results from a GREEK Single-Centre Study
Abstract
:1. Introduction
2. Results
3. Discussion
4. Materials and Methods
4.1. Study Population
4.2. Lactate Measurement
4.3. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | All Patients | Survivors | Non-Survivors | p-Value |
---|---|---|---|---|
Number of patients, N (%) | 45 | 34 (75.6%) | 11 (24.4%) | |
Age (years), (mean ± SD) | 64 ± 10 | 63 ± 10 | 67 ± 10 | 0.244 |
Sex, N (%) | 0.765 | |||
Male | 33 (73.3%) | 24 (72.7%) | 9 (27.3%) | |
Female | 12 (26.7%) | 10 (83.3%) | 2 (16.7%) | |
Comorbidities, N (%) | 0.887 | |||
Hypertension | 18 | 15 (83.3%) | 3 (16.7%) | |
Diabetes | 5 | 3 (60.0%) | 2 (40.0%) | |
Coronary artery disease | 3 | 1 (33.3%) | 2 (66.7%) | |
COPD | 1 | 0 (0.0%) | 1 (100.0%) | |
Asthma | 1 | 1 (100.0%) | 0 (0.0%) | |
Hyperlipidaemia | 10 | 8 (80.0%) | 2 (20.0%) | |
Chronic kidney disease | 1 | 0 (0.0%) | 1 (100.0%) | |
Hepatitis | 1 | 1 (100.0%) | 0 (0.0%) | |
Characteristics on ICU Admission | ||||
APACHE II score, (median, IQR) | 17 (14–19) | 16 (14–18) | 18 (16–22) | 0.025 * |
SOFA score, (median, IQR) | 9 (8–10) | 8 (7–10) | 10 (8–11) | 0.031 * |
PaO2/FiO2 (mmHg), (mean ± SD) | 166 ± 70 | 171 ± 71 | 151 ± 70 | 0.418 |
PCO2 (mmHg), (mean ± SD) | 45 ± 9 | 44 ± 7 | 50 ± 13 | 0.051 |
pH, (median, IQR) | 7.33 (7.29–7.45) | 7.36 (7.31–7.45) | 7.31 (7.25–7.38) | 0.063 |
HCO3 (mEq/L), (median, IQR) | 23 (21–27) | 23 (21–25) | 21 (21–30) | 0.474 |
Vitals signs | ||||
Heart rate (bpm), (mean ± SD) | 84 ± 28 | 87 ± 25 | 77 ± 37 | 0.247 |
Mean Arterial pressure (mmHg), (median, IQR) | 78 (70–90) | 77 (70–84) | 78 (68–105) | 0.71 |
Respiratory rate (breaths/min), (mean ± SD) | 22 ± 3 | 21 ± 3 | 24 ± 3 | 0.023 * |
Temperature (°C), (mean ± SD) | 37.0 ± 1.4 | 37.3 ± 1.2 | 36.0 ± 1.6 | 0.0051 * |
Laboratory data | ||||
Haemoglobin, (mean ± SD) | 12.4 ± 2.2 | 12.8 ± 1.8 | 11.2 ± 2.8 | 0.033 * |
Haematocrit, (mean ± SD) | 37.3 ± 6.3 | 38.6 ± 4.7 | 33.4 ± 8.8 | 0.015 * |
White Blood Cell count (per μL), (median, IQR) | 9400 (5200–11,750) | 9050 (5275–10,868) | 12,800 (1300–154,100) | 0.572 |
Neutrophils (%), (median, IQR) | 82.0 (78.0–87.5) | 81.5 (78.6–87.0) | 86.0 (72.0–90.0) | 0.891 |
Lymphocytes (%), (median, IQR) | 13.0 (7.5–18.5) | 13.0 (8.0–18.3) | 9.0 (5.0–21.0) | 0.561 |
Platelets (per μL), (mean ± SD) | 196,844 ± 85,148 | 207,912 ± 63,197 | 162636 ± 130449 | 0.127 |
PT (sec), (median, IQR) | 13 (13–14) | 13 (13–14) | 13 (12–14) | 0.923 |
APTT (sec), (mean ± SD) | 34.3 ± 5.5 | 34.3 ± 5.8 | 34.5 ± 5.1 | 0.923 |
INR, (median, IQR) | 1.06 (1.00–1.10) | 1.06 (1.00–1.10) | 1.07 (1.00–1.13) | 0.881 |
Creatinine (mg/dL), (mean ± SD) | 1.1 ± 0.5 | 0.9 ± 0.2 | 1.5 ± 0.8 | 0.0003 * |
Glucose (mg/dL), (median, IQR) | 142 (117–189) | 142 (116–186) | 145 (117–262) | 0.525 |
Total Bilirubin (mg/dL), (median, IQR) | 0.6 (0.5–0.8) | 0.6 (0.5–0.8) | 0.5 (0.4–0.8) | 0.321 |
Albumin (g/dL), (mean ± SD) | 3.4 ± 0.5 | 3.4 ± 0.5 | 3.1 ± 0.5 | 0.129 |
Globulin (g/dL), (mean ± SD) | 2.6 ± 0.5 | 2.7 ± 0.5 | 2.3 ± 0.7 | 0.064 |
CKMB (IU/L), (median, IQR) | 24.0 (15.5–32.5) | 23.5 (14.8–33.0) | 25.0 (20.0–32.0) | 0.711 |
CK (U/L), (median, IQR) | 159.0 (55.5–365.0) | 169.5 (63.8–364.8) | 137.0 (21.0–376.0) | 0.493 |
Fibrinogen (mg/dL), (mean ± SD) | 632.6 ± 166.3 | 652.7 ± 157.7 | 570.5 ± 184.5 | 0.157 |
CRP (mg/dL), (mean ± SD) | 17.0 ± 11.6 | 15.9 ± 9.3 | 20.4 ± 17.1 | 0.269 |
γ-GT (IU/L), (median, IQR) | 59.0 (27.0–113.0) | 62.0 (27–122.5) | 42.0 (24.0–78.0) | 0.225 |
Urea (mg/dL), (median, IQR) | 34.0 (27.0–49.5) | 31.0 (24.8–41.0) | 46.0 (39.0–89.0) | 0.0013 * |
AST (IU/L), (median, IQR) | 42.0 (28.5–58.5) | 42.5 (33.8–60.0) | 28.0 (26.0–58.0) | 0.274 |
ALT (IU/L), (mean ± SD) | 39.2 ± 20.9 | 40.4 ± 20.4 | 35.6 ± 23.1 | 0.506 |
Na+ (mEq/L), (mean ± SD) | 137.9 ± 5.8 | 138.0 ± 5.1 | 137.5 ± 8.0 | 0.779 |
K+ (mg/dL), (mean ± SD) | 4.1 ± 0.7 | 4.2 ± 0.7 | 3.8 ± 0.7 | 0.117 |
ALP (U/L), (median, IQR) | 67.0 (45.0–105.0) | 65.5 (43.8–130.8) | 67.0 (52.0–102.0) | 0.740 |
LDH (U/L), (median, IQR) | 479.0 (347.0–631.5) | 482.5 (356.5–630.3) | 470.0 (235.0–637.0) | 0.636 |
High-sensitive troponin T (ng/mL), (median, IQR) | 15 (10–42) | 12 (10–28) | 33 (16–83) | 0.013 * |
Amylase (U/L), (median, IQR) | 65.0 (38.5–97.8) | 66.0 (38.0–106.0) | 56.0 (40.0–97.0) | 0.693 |
Lactate (mmol/L) | 1.4 (1.1–2.1) | 1.4 (1.0–1.8) | 2.0 (1.4–2.3) | 0.0066 * |
COVID-19-Targeted Treatment | 0.81 | |||
Azithromycin/chloroquine/lopinavir/ritonavir | 20 | 17 | 3 | |
Azithromycin/chloroquine | 15 | 10 | 5 | |
Lopinavir/ritonavir/chloroquine | 5 | 4 | 1 | |
Chloroquine | 4 | 2 | 2 | |
Plasma | 1 | 1 | 0 | |
Outcomes | ||||
LoS in the ICU (days), (median, IQR) | 13.0 (8.0–17.0) | 13.0 (10.0–19.0) | 8.0 (4.0–11.0) | 0.007 * |
Mechanical ventilation, N (%) | 39 | 28 | 11 | ns |
Duration of mechanical ventilation (days), (median, IQR) | 10.0 (4.0–14.0) | 10.0 (3.0–16.0) | 8.0 (4.0–11.0) | ns |
Variable | Univariate RR | 95% CI | p |
---|---|---|---|
APACHE II score (per 1 unit increase) | 1.235 | 1.033–1.476 | 0.020 * |
SOFA score (per 1 unit increase) | 1.424 | 0.939–2.160 | 0.096 |
Lactate (per 0.1 mmol/L increase) | 2.911 | 1.552–5.460 | 0.001 * |
Troponin T (per 1 ng/mL) | 1.004 | 1.001–1.007 | 0.015 * |
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Vassiliou, A.G.; Jahaj, E.; Ilias, I.; Markaki, V.; Malachias, S.; Vrettou, C.; Ischaki, E.; Mastora, Z.; Douka, E.; Keskinidou, C.; et al. Lactate Kinetics Reflect Organ Dysfunction and Are Associated with Adverse Outcomes in Intensive Care Unit Patients with COVID-19 Pneumonia: Preliminary Results from a GREEK Single-Centre Study. Metabolites 2020, 10, 386. https://doi.org/10.3390/metabo10100386
Vassiliou AG, Jahaj E, Ilias I, Markaki V, Malachias S, Vrettou C, Ischaki E, Mastora Z, Douka E, Keskinidou C, et al. Lactate Kinetics Reflect Organ Dysfunction and Are Associated with Adverse Outcomes in Intensive Care Unit Patients with COVID-19 Pneumonia: Preliminary Results from a GREEK Single-Centre Study. Metabolites. 2020; 10(10):386. https://doi.org/10.3390/metabo10100386
Chicago/Turabian StyleVassiliou, Alice G., Edison Jahaj, Ioannis Ilias, Vassiliki Markaki, Sotirios Malachias, Charikleia Vrettou, Eleni Ischaki, Zafeiria Mastora, Evangelia Douka, Chrysi Keskinidou, and et al. 2020. "Lactate Kinetics Reflect Organ Dysfunction and Are Associated with Adverse Outcomes in Intensive Care Unit Patients with COVID-19 Pneumonia: Preliminary Results from a GREEK Single-Centre Study" Metabolites 10, no. 10: 386. https://doi.org/10.3390/metabo10100386