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Identification and Quantification of Deranged Metabolites in Critically Ill Patients Using NMR-Based Metabolomics
Published on: November 29, 2024
Early lactate trajectories predict mortality in sepsis-associated acute lung injury: A retrospective cohort study
Yaoxian Wang1, Guoming Chen1, Mei Han1
1Department of Emergency Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
Background:
Sepsis-associated acute lung injury (SALI) is a life-threatening respiratory condition with high mortality. Serum lactate is a key marker of oxygen metabolism and tissue hypoperfusion. This study aimed to investigate whether dynamic lactate trajectories in the early ICU period could predict 28-day mortality in SALI patients.
Methods:
We retrospectively analyzed 340 patients with SALI from the MIMIC-IV database. Lactate trajectories over the first three ICU days were identified using latent growth mixture modeling (LGMM). Cox proportional hazards models and Kaplan-Meier survival analyses were used to evaluate the association between trajectory classes and 28-day mortality. The prognostic performance of SOFA score alone and in combination with lactate trajectory was compared using ROC curves.
Results:
Three distinct lactate trajectory classes were identified: persistently elevated, low and stable, and initially elevated then declining. Patients in the low-stable and moderate-declining groups had significantly lower mortality risks compared to those with persistently high lactate. Adding lactate trajectory to SOFA improved AUC from 0.629 to 0.693 (P = 0.0074).
Conclusion:
Early lactate trajectory classification is an independent predictor of mortality in SALI patients and enhances prognostic performance beyond SOFA. Incorporating trajectory-based risk stratification may inform more personalized respiratory management strategies.
