Associations between Late Lactate Clearance and Clinical Outcomes in Adults with Hyperlactataemia in the Setting of Diabetic Ketoacidosis
Abstract
:1. Introduction
2. Materials and Methods
Data Management and Statistical Analysis
3. Results
Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Predictor | β (95% CI) | p-Value |
---|---|---|
Early lactate clearance | +18.23 (+1.03, +35.43) | 0.039 |
Age (years) | −0.12 (−0.36, +0.13) | 0.355 |
Female sex | +7.52 (−0.27, +15.31) | 0.059 |
Co-morbidities | ||
Renal | +0.16 (−37.44, +37.77) | 0.993 |
Respiratory | −31.29 (−65.05, +2.47) | 0.062 |
Cardiovascular | +5.64 (−21.06, +32.35) | 0.679 |
Frailty score (referenced to 1) | ||
2 | −9.74 (−37.85, +18.37) | 0.497 |
3 | −23.63 (−52.31, +5.06) | 0.107 |
4 | −27.34 (−58.24, +3.56) | 0.096 |
5 | −31.99 (−68.02, + 4.05) | 0.102 |
6 | −24.09 (−55.04, +6.87) | 0.127 |
7 | −38.74 (−86.14, +8.66) | 0.134 |
8 | −58.01 (−145.77, +29.76) | 0.195 |
BMI (kg/m2) | +0.07 (−0.62, +0.77) | 0.839 |
APACHE-III Score | +0.70 (+0.52, +0.87) | <0.001 |
Predictor | β (95% CI) | p-Value |
---|---|---|
Early lactate resolution | +8.23 (+0.03, +16.43) | 0.049 |
Age (years) | +1.01 (−0.89, +1.13) | 0.332 |
Female sex | +13.38 (−12.97, +39.35) | 0.713 |
Co-morbidities | ||
Renal | −0.48 (−2.69, +1.74) | 0.681 |
Respiratory | −14.18 (−25.62, +2.73) | 0.064 |
Cardiovascular | +10.16 (−8.76, +29.08) | 0.293 |
Frailty score (referenced to 1) | ||
2 | +3.29 (−59.35, +65.95) | 0.918 |
3 | +25.39 (−38.11, +88.90) | 0.433 |
4 | +9.60 (−57.62, +76.81) | 0.780 |
5 | +82.99 (−6.93, +172.91) | 0.070 |
6 | +60.16 (−23.45, +143.77) | 0.158 |
7 | +13.69 (−2.09, +25.29) | 0.212 |
8 | +11.49 (−252.61, +275.58) | 0.932 |
BMI (kg/m2) | +0.62 (−1.47, +2.71) | 0.561 |
APACHE-III Score | +1.78 (+1.13, +2.42) | <0.001 |
Number of Comorbidities | Early Lactate Clearance N = 427 | Late Lactate Clearance N = 84 1 | p-Value 2 |
---|---|---|---|
0 | 119 (27.9%) | 17 (20.2%) | 0.423 |
1 | 281 (65.8%) | 62 (73.8%) | |
2 | 15 (3.5%) | 5 (6.0%) | |
3 | 9 (2.1%) | 0 | |
4 | 3 (0.7%) | 0 | |
5 | 0 | 0 |
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Variable | Early Lactate Clearance 1 n = 427 | Late Lactate Clearance 1 n = 84 | p-Value 2 |
---|---|---|---|
Age (years) | 53 (34, 61) | 49 (30, 59) | 0.301 |
Male sex | 219 (51.3%) | 27 (32.5%) | 0.011 |
Comorbidities | |||
Respiratory | 6 (1.41%) | 2 (2.41%) | 0.501 |
Cardiovascular | 5 (1.17%) | 1 (1.20%) | 0.981 |
Renal | 17 (3.98%) | 1 (1.20%) | 0.207 |
IDDM | 367 (85.9%) | 68 (81.0%) | 0.975 |
Pressure injury | 8 (1.87%) | 1 (1.82%) | 0.925 |
Risk of Death Scores | |||
APACHE-II Score | 21 (16, 25) | 25 (18, 28) | 0.545 |
APACHE-III Score | 59 (47, 76) | 77 (60, 96) | 0.139 |
APACHE-III Risk of death (%) | 0.038 (0.019, 0.057) | 0.043 (0.018, 0.068) | 0.176 |
ANZROD (%) | 0.008 (0.003, 0.013) | 0.011 (0.004, 0.018) | 0.381 |
Variable | Early Lactate Clearance N = 427 | Late Lactate Clearance N = 84 1 | p-Value 2 |
---|---|---|---|
Lactate (mmol/L) | 2.8 (2.2, 3.5) | 5.3 (4.0, 6.7) | <0.001 |
Electrolytes | |||
Sodium (Na+) (mmol/L) | 136 (133, 139) | 139 (133, 145) | 0.041 |
Potassium (K+) (mmol/L) | 4.1 (3.5, 4.5) | 4.0 (3.5, 4.4) | 0.974 |
Chloride (mmol/L) | 107 (103, 113) | 109 (105, 113) | 0.138 |
Ionised calcium (mmol/L) | 1.20 (1.13, 1.24) | 1.19 (1.14, 1.26) | 0.539 |
Anion gap (mmol/L) | 18 (13, 23) | 22 (15, 28) | 0.032 |
Blood glucose (mmol/L) | 25 (14, 36) | 26 (14, 37) | 0.867 |
Creatinine (µmol/L) | 95 (65, 123) | 115 (50, 260) | 0.062 |
Acid-base | |||
pH | 7.26 (7.15, 7.32) | 7.23 (7.10, 7.31) | 0.663 |
paCO2 (mmHg) | 21 (14, 27) | 20 (15, 25) | 0.937 |
paO2 (mmHg) | 104 (78, 123) | 116 (95, 138) | 0.798 |
Bicarbonate (mmol/L) | 11 (6, 15) | 7 (4, 13) | 0.065 |
Base Excess (mmol/L) | −13 (−20, −6) | −15 (−22, −11) | 0.102 |
Oximetry | |||
Haemoglobin (g/L) | 112 (98, 126) | 115 (99, 128) | 0.851 |
Oxyhaemoglobin (%) | 96 (93, 97) | 96 (95, 97) | 0.935 |
Carboxyhaemoglobin (%) | 0.8 (0.3, 1.3) | 0.8 (0.3, 1.2) | 0.946 |
Methaemoglobin (%) | 0.5 (0.3, 1.0) | 0.5 (0.3, 1.2) | 0.829 |
Variable | Early Lactate Clearance N = 427 1 | Late Lactate Clearance N = 84 1 | p-Value 2 |
---|---|---|---|
Length of stay (hours) | |||
ICU | 53 (34, 61) | 49 (30, 59) | 0.301 |
Hospital | 219 (51.3%) | 27 (32.5%) | 0.011 |
IPPV | 34 (7.9%) | 13 (22.4%) | 0.034 |
NIV | 7 (1.6%) | 4 (6.9%) | 0.079 |
Vasopressors | 59 (13.8%) | 25 (43.1%) | <0.001 |
RRT | 14 (3.3%) | 4 (6.9%) | 0.497 |
Ventilation hours | |||
IPPV | 68 (30, 137) | 73 (42, 171) | 0.736 |
NIV | 5 (1, 8) | 11 (6, 11) | 0.002 |
Variable | β (95% CI) | p-Value |
---|---|---|
ICU Length of Stay | ||
Late lactate clearance | +15.82 (+0.05, +31.59) | 0.049 |
APACHE-III Score | +1.05 (+0.88, +1.22) | <0.001 |
Hospital Length of Stay | ||
Late lactate clearance | +7.24 (+0.11, +14.37) | 0.048 |
APACHE-III Score | +3.40 (+2.22, +4.57) | <0.001 |
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Kumar, A.; Anstey, C.; Doola, R.; Mcllroy, P.; Whebell, S.; Shekar, K.; Attokaran, A.; Marella, P.; White, K.; Luke, S.; et al. Associations between Late Lactate Clearance and Clinical Outcomes in Adults with Hyperlactataemia in the Setting of Diabetic Ketoacidosis. J. Clin. Med. 2024, 13, 4933. https://doi.org/10.3390/jcm13164933
Kumar A, Anstey C, Doola R, Mcllroy P, Whebell S, Shekar K, Attokaran A, Marella P, White K, Luke S, et al. Associations between Late Lactate Clearance and Clinical Outcomes in Adults with Hyperlactataemia in the Setting of Diabetic Ketoacidosis. Journal of Clinical Medicine. 2024; 13(16):4933. https://doi.org/10.3390/jcm13164933
Chicago/Turabian StyleKumar, Aashish, Christopher Anstey, Ra’eesa Doola, Philippa Mcllroy, Stephen Whebell, Kiran Shekar, Antony Attokaran, Prashanti Marella, Kyle White, Stephen Luke, and et al. 2024. "Associations between Late Lactate Clearance and Clinical Outcomes in Adults with Hyperlactataemia in the Setting of Diabetic Ketoacidosis" Journal of Clinical Medicine 13, no. 16: 4933. https://doi.org/10.3390/jcm13164933