Prognostic value of blood gas lactate levels among COVID-19 patients

Nihat Müjdat Hökenek 1, Rohat Ak 1 *
More Detail
1 Department of Emergency Medicine, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 4, pp. 87-90. https://doi.org/10.23950/jcmk/11130
OPEN ACCESS 1488 Views 1081 Downloads
Download Full Text (PDF)

ABSTRACT

Objective: Our aim in this study to determine the relationship between the blood gas lactate values of the patients who have 2019 coronavirus disease (COVID-19) at the time of admission to the emergency department (ED) and the mortality status of these patients and the intensive care unit (ICU) requirement.
Methods: This retrospective observational study was conducted with patients who were diagnosed with COVID-19 in the emergency department of a tertiary hospital. The study was continued with the remaining 292 patients after using the inclusion and exclusion criteria. Patients included in the study were divided into 2 groups according to their lactate levels (Lactate ≤ 2 mmol/L and Lactate > 2 mmol/L). Then we compared the groups according to their ICU requirement and mortality status.
Results: There were 292 patients included in this study. The mean age of the patients was 68.3 ± 15.9, of which 158 were men and 134 were women.  Hyperlactatemia (lactate >2) was found in 136 (46.6%) of the 292 patients included in the study, while 156 (53.4%) had normal lactate levels (lactate ≤2). The most common comorbidities in the patients were hypertension (HT), diabetes mellitus (DM), and cardiovascular diseases. ICU requirements and mortality status of the patients in the study, when compared with lactate levels, the mortality and ICU rates of the hyperlactatemia group were statistically higher.
Conclusion: Our study found that hyperlactatemic COVID-19 patients had higher ICU requirement and mortality rates compared to non-hyperlactatemic patients. Prospective studies with larger sample sizes are necessary to adequately assess the relationship between lactate and mortality in COVID-19 patients.
Keywords: COVID-19, lactate, intensive care units, mortality

CITATION

Hökenek NM, Ak R. Prognostic value of blood gas lactate levels among COVID-19 patients. J CLIN MED KAZ. 2021;18(4):87-90. https://doi.org/10.23950/jcmk/11130

REFERENCES

  • Huang C, Wang Y, Li X, Ren N, Zhao Jet al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497‐506. doi: 10.1016/S0140- 6736(20)30183-5.
  • Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: Early experience and forecast during an emergency response. JAMA: e Journal of the American Medical Association 2020. doi:10.1001/ jama.2020.4031
  • Ak, R., Kurt, E., & Bahadirli, S. (2021). Comparison of 2 Risk Prediction Models Specific for COVID-19: The Brescia-COVID Respiratory Severity Scale Versus the Quick COVID-19 Severity Index. Disaster Medicine and Public Health Preparedness, 1-5.
  • WangD, HuB, HuC, ZhuF, LiuX etal. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus- infected pneumonia in Wuhan, China. JAMA: e Journal of the American Medical Association 2020; 323(11): 1061-1069. doi: 10.1001/jama.2020.1585
  • Doğanay, F., Elkonca, F., Seyhan, A. U., Yılmaz, E., Batırel, A., & Ak, R. (2021). Shock index as a predictor of mortality among the Covid-19 patients. The American journal of emergency medicine, 40, 106-109.
  • Ye Q, Wang B, Mao J. e pathogenesis and treatment of the `Cytokine Storm’ in COVID-19. e Journal of Infection 2020; 80 (6): 607‐613. doi: 10.1016/j.jinf.2020.03.037
  • Khosravani, H., Shahpori, R., Stelfox, H. T., Kirkpatrick, A. W., & Laupland, K. B. (2009). Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Critical Care, 13(3), 1-5.
  • Cerović, O., Golubović, V., Špec-Marn, A., Kremžar, B., & Vidmar, G. (2003). Relationship between injury severity and lactate levels in severely injured patients. Intensive care medicine, 29(8), 1300-1305.
  • Nguyen, H. B., Rivers, E. P., Knoblich, B. P., Jacobsen, G., Muzzin, A., Ressler, J. A., & Tomlanovich, M. C. (2004). Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Critical care medicine, 32(8), 1637-1642.
  • World Health Organisation (WHO) Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases. Geneva. Interim guidance 19 March 2020. Available at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance\ Accessed 15 March 2020.
  • Sakal, C., Ak, R., Taşçı, A., Deniz Kırkpantur, E., Ünal Akoğlu, E., & Cimilli Ozturk, T. (2021). Admission blood lactate levels of patients diagnosed with cerebrovascular disease effects on short and long‐term mortality risk. International Journal of Clinical Practice, e14161.
  • Richardson, S., Hirsch, J. S., Narasimhan, M., Crawford, J. M., McGinn, T., Davidson, K. W., ... & Zanos, T. P. (2020). Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. Jama, 323(20), 2052-2059.
  • Wu, C., Chen, X., Cai, Y., Zhou, X., Xu, S., Huang, H., ... & Song, Y. (2020). Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine, 180(7), 934-943.
  • Guzik, T. J., Mohiddin, S. A., Dimarco, A., Patel, V., Savvatis, K., Marelli-Berg, F. M., ... & McInnes, I. B. (2020). COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovascular research, 116(10), 1666-1687.
  • Baron AD, Brechtel-Hook G, Johnson A, Hardin D. Skeletal muscle blood ow. A possible link between insulin resistance and blood pres- sure. Hypertension 1993; 21:129–135.
  • Juraschek, S. P., Bower, J. K., Selvin, E., Subash Shantha, G. P., Hoogeveen, R. C., Ballantyne, C. M., & Young, J. H. (2015). Plasma lactate and incident hypertension in the atherosclerosis risk in communities study. American journal of hypertension, 28(2), 216-224.
  • Ryoo, S. M., Lee, J., Lee, Y. S., Lee, J. H., Lim, K. S., Huh, J. W., ... & Kim, W. Y. (2018). Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by sepsis-3. Critical care medicine, 46(6), e489-e495.
  • Woolum, J. A., Abner, E. L., Kelly, A., Bastin, M. L. T., Morris, P. E., & Flannery, A. H. (2018). Effect of thiamine administration on lactate clearance and mortality in patients with septic shock. Critical care medicine, 46(11), 1747-1752.
  • Hernández, G., Ospina-Tascón, G. A., Damiani, L. P., Estenssoro, E., Dubin, A., Hurtado, J., ... & Bakker, J. (2019). Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the ANDROMEDA-SHOCK randomized clinical trial. Jama, 321(7), 654-664.
  • Vincent JL, Quintairos E, Silva A, Couto Jr L, Taccone FS. The value of blood lactate kinetics in critically ill patients: asystematic review. Crit Care. 2016; 20:257. https://doi.org/10.1186/s13054-016-1403-5
  • Ibrahim, A., Bayramoglu, B., Hokenek, N. M., & Tekyol, D. (2021). Lactate clearance during the first 2 hours after hospital admission: A useful biomarker for predicting 30‐day mortality in patients with diabetic ketoacidosis. International Journal of Clinical Practice, e14204.
  • Seda Beyhan Sagmen, Tugba Naziroglu.Relationship between lactate level and length of hospital stay in patients with a COPD exacerbation. J Clin Med Kaz. 2020; 3(57):19-23
  • 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.