Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • F S Frenzen - , Universitätsklinikum Carl Gustav Carus Dresden (Autor:in)
  • U Kutschan - , Universitätsklinikum Carl Gustav Carus Dresden (Autor:in)
  • N Meiswinkel - , Medizinische Klinik und Poliklinik I, Division of Pulmonology, Universitätsklinikum Carl Gustav Carus Dresden (Autor:in)
  • B Schulte-Hubbert - , Medizinische Klinik und Poliklinik I, Division of Pulmonology, Universitätsklinikum Carl Gustav Carus Dresden (Autor:in)
  • S Ewig - , Thoraxzentrum Ruhrgebiet (Autor:in)
  • M Kolditz - , Medizinische Klinik und Poliklinik I, Division of Pulmonology, Universitätsklinikum Carl Gustav Carus Dresden (Autor:in)

Abstract

OBJECTIVES: Community-acquired pneumonia (CAP) is associated with a high risk of respiratory failure or septic organ dysfunction. Lactate is an established early marker of prognosis and sepsis severity, but few data exist in patients with CAP.

METHODS: We performed a retrospective cohort study of consecutive adult CAP patients without treatment restrictions or direct intensive care unit admission. Lactate was measured as a point-of-care test within the capillary admission blood gas analysis, and its prognostic value was compared to the CRB/CURB-65 criteria by multivariate and receiver operating characteristic (ROC) curve analysis. The primary endpoint was the combination of need for mechanical ventilation, vasopressors, intensive care unit admission or hospital mortality.

RESULTS: Of 303 included patients, 75 (25%) met the primary endpoint. After ROC analysis, lactate predicted the primary endpoint (area under the curve 0.67) with an optimal cutoff of >1.8 mmol/L. Of the 76 patients with lactate above this threshold, 35 (46%) met the primary endpoint. After multivariate analysis, the predictive value of lactate was independent of the CRB/CURB-65 scores. The addition of lactate >1.8 mmol/L to the CRB/CURB-65 scores resulted in significantly improved area under the curves (0.69 to 0.74, p 0.005 and 0.71 to 0.75, p 0.008 respectively). Fourteen (42%) of 33 and 11 (39%) of 28 patients meeting the endpoint despite presenting with 0 or 1 CRB/CURB-65 criteria had lactate >1.8 mmol/L.

CONCLUSIONS: Admission lactate levels significantly improved the prognostic value of the CRB/CURB-65 scores in CAP patients. Lactate may therefore be considered a rapid, cheap and broadly available additional criterion for the assessment of risk in patients with CAP.

Details

OriginalspracheEnglisch
Seiten (von - bis)306.e1-306.e6
FachzeitschriftClinical Microbiology and Infection
Jahrgang24
Ausgabenummer3
PublikationsstatusVeröffentlicht - März 2018
Peer-Review-StatusJa

Externe IDs

ORCID /0000-0001-6022-6827/work/127321432
Scopus 85028560761

Schlagworte

Schlagwörter

  • Adolescent, Adult, Aged, Aged, 80 and over, Community-Acquired Infections/diagnosis, Diagnostic Tests, Routine, Female, Humans, Lactic Acid/blood, Male, Middle Aged, Pneumonia/diagnosis, Predictive Value of Tests, Prognosis, ROC Curve, Respiration, Artificial/statistics & numerical data, Retrospective Studies, Severity of Illness Index, Survival Analysis, Young Adult