Relationship between lactate level and length of hospital stay in patients with a COPD exacerbation

Seda Beyhan Sagmen 1 * , Tugba Naziroglu 2
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1 Department of Pulmonary Medicine, Kartal Dr. Lutfi Kirdar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
2 Department of Pulmonary Medicine, Bingol State Hospital, Bingol, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 3, Issue 57, pp. 19-23. https://doi.org/10.23950/1812-2892-JCMK-00733
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ABSTRACT

Objective: To investigate the effect of lactate levels on length of hospital stay in patients with chronic obstructive pulmonary disease exacerbation.
Material and methods: Patients who were hospitalized for chronic obstructive pulmonary disease exacerbation between October 2017 and December 2018 were evaluated. Those who had pneumonia or any other additional disease that might affect the lactate level during hospitalization were excluded from the study. The arterial blood gas parameters and lactate levels measured at the time of hospitalization were examined. The patients were divided into two groups according to the length of stay: longer than seven days and shorter than seven days. The relationship of lactate levels with the length of hospital stay and requiring non-invasive mechanical ventilation during hospitalization was investigated.
Results: A total of 101 patients, 28 females (27.72%) and 73 males (72.28%), participated in the study. The mean age of the patients was 68±9 years. Fifty-seven (56.44%) patients were hospitalized for 7 days or less and 44 patients (43.56%) were hospitalized for more than 7 days. The mean length of hospital stay was 7.37 ± 2.24 days. An examination of the relationship between lactate and length of hospital stay revealed a significant correlation (p<0.001; r=0.791). When the patients were divided into two groups according to their length of hospital stay, lactate levels were found to be higher in patients who were hospitalized for longer than seven days (2.74±0.74) compared with patients who were hospitalized for seven days or less (1.50±0.58) (p<0.001). The body mass index of patients hospitalized for longer than seven days was found to be lower than in the patients hospitalized for seven days or less (p<0.001). The lactate levels of the patients requiring non-invasive mechanical ventilation were found to be higher (2.29±0.91) than the other patients (1.70±0.76) (p=0.001). A determinative cut-off point was examined for the lactate level in hospitalizations of patients. When the lactate value was taken as 1.95, 90.91% sensitivity and 84.21% specificity were obtained.
Conclusion: Lactate levels may become important in clinical practice to predict the duration of hospitalization because it can be measured quickly and easily.
Keywords: lactate, chronic obstructive pulmonary disease, length of hospital stay, non-invasive mechanical ventilation

CITATION

Beyhan Sagmen S, Naziroglu T. Relationship between lactate level and length of hospital stay in patients with a COPD exacerbation. Journal of Clinical Medicine of Kazakhstan. 2020;3(57):19-23. https://doi.org/10.23950/1812-2892-JCMK-00733

REFERENCES

  • Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2017. Available from: http://goldcopd.org
  • Celi BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004; 23:932-46. https://doi.org/10.1183/09031936.04.00014304
  • Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet. 2007; 370:786-96. https://doi.org/10.1016/S0140-6736(07)61382-8
  • Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000; 161:1608-13. https://doi.org/10.1164/ajrccm.161.5.9908022
  • Vernon C, Letourneau JL. Lactic acidosis: Recognition, kinetics, and associated prognosis. Crit Care Clin. 2010; 26:255-83. https://doi.org/10.1016/j.ccc.2009.12.007
  • Revelly JP, Tappy L, Martinez A, et al. Lactate and glucose metabolism in severe sepsis and cardiogenic shock. Crit Care Med. 2005; 33:2235-40. https://doi.org/10.1097/01.CCM.0000181525.99295.8F
  • Bernardin G, Pradier C, Tiger F, Deloffre P, Mattei M. Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shock. Intensive Care Med. 1996; 22:17-25. https://doi.org/10.1007/BF01728326
  • Kurt NG, Orak M, Üstündağ M. The role of lactate clearance on deciding discharge in exacerbation of chronic obstructive pulmonary disease: Retrospective cohort study. J Surg Med. 2018; 2(2):96-98.
  • Vincent JL, Quintairos E, Silva A, Couto Jr L, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care. 2016; 20:257. https://doi.org/10.1186/s13054-016-1403-5
  • Régnier MA, Raux M, Le Manach Y, Asencio Y, Gaillard J, Devilliers C, et al. Prognostic significance of blood lactate and lactate clearance in trauma patients. Anesthesiology. 2012; 117:1276-88. https://doi.org/10.1097/ALN.0b013e318273349d
  • Andersen LW, Holmberg MJ, Doherty M, Khabbaz K, Lerner A, Berg KM, Donnino MW. Postoperative lactate levels and hospital length of stay after cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2015; 29 (6):1454-1460. https://doi.org/10.1053/j.jvca.2015.06.007
  • Durmuş U, Nurettin ÖD, Pekdemir M, Yılmaz S, Yaka E, Karadaş A, Pınar SG. The value of lactate clearance in admission decisions of patients with acute exacerbation of COPD. American Journal of Emergency Medicine. 2018; 36(6):972-976. https://doi.org/10.1016/j.ajem.2017.11.002
  • Demers P, Elkouri S, Martineau R, Couturier A, Cartier R. Outcome with high blood lactate levels during cardiopulmonary bypass in adult cardiac operation. Ann Thorac Surg. 2000; 70:2082-6. https://doi.org/10.1016/S0003-4975(00)02160-3
  • Jelena Veličković, Ivan Palibrk, Biljana Miličić , Dejan Veličković, Bojan Jovanović, Goran Rakić, Milorad Petrović, Vesna Bumbaširević. The association of early postoperative lactate levels with morbidity after elective major abdominal surgery. Bosn J Basic Med Sci. 2019; 19(1):72-80 https://doi.org/10.17305/bjbms.2018.3186
  • Scott HF, Donoghue AJ, Gaieski DF, Marchese RF, Mistry RD. The utility of early lactate testing in undifferentiated pediatric systemic inflammatory response syndrome. Acad Emerg Med. 2012; 19(11):1276-80. https://doi.org/10.1111/acem.12014
  • Reed L, Carroll J, Cummings A, Markwell S, Wall J, Duong M. Serum lactate as a screening tool and predictor of outcome in pediatric patients presenting to the ED with suspected infection. Pediatr Emerg Care. 2013; 29(7):787-91. https://doi.org/10.1097/pec.0b013e318298389d
  • Okorie ON, Dellinger P. Lactate: Biomarker and potential therapeutic target. Crit Care Clin. 2011; 27(2):299-326. https://doi.org/10.1016/j.ccc.2010.12.013
  • Shalaby A, Khalafallah O, Galal M, Assal HH, Ahmed N. Correlation between serum lactate and other oxygenation indices as a predictor of outcome in respiratory ICU patients. Egyptian Journal of Chest Diseases and Tuberculosis. 2016; 65:695-700. https://doi.org/10.1016/j.ejcdt.2016.04.010
  • B.R. Widgren, M. Grunstra, Serum lactate-useful indicator in emergency care. Läkartidningen. 2011; 108(9):475-477.
  • Danith P A van den Nouland, Martijn C G J Brouwers, Patricia M StassenPrognostic value of plasma lactate levels in a retrospective cohort presenting at a university hospital ED. BMJ Open. 2017; 7:e011450. https://doi.org/10.1136/bmjopen-2016-011450
  • Güzel M, Atay E, Terzi Ö, Demir MC, Erenler AK, Demir MT. The Role of Lactate and Troponin-I Levels in Predicting Length of Hospital Stay in Patients with Carbon Monoxide Poisoning. Clin Lab. 2019; 1;65(5). https://doi.org/10.7754/Clin.Lab.2018.180929
  • Nanda SK, Murthy H. Role of plasma lactate and arterial blood gas as prognostic marker in Acute respiratory distress syndrome patients receiving mechanical ventilation. Biomedical Research. 2011; 22(4)