Association Between Lactate and ICU-Acquired Infection in Critically Ill Patients With Sepsis: A Retrospective Study...

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Biomarkers

Background:

• Sepsis is a major cause of ICU mortality, frequently leading to immunosuppression and secondary ICU-acquired infections (IAI).
• IAI exacerbates sepsis severity, increasing the risk of chronic critical illness (CCI).
• Reliable biomarkers for early IAI detection are scarce, necessitating research into existing prognostic markers.

Purpose of the Study:

• To investigate the association between early blood lactate levels and the incidence of IAI in intensive care unit (ICU) patients.
• To determine if admission lactate levels can serve as a predictive marker for IAI development.

Main Methods:

• Retrospective analysis of 17,209 patients from the MIMIC-IV database (v3.0).
• Evaluation of the relationship between admission lactate concentrations and IAI occurrence.
• Multivariable regression analysis to adjust for confounding factors and assess independent associations.

Main Results:

• A dose-response relationship was observed between admission lactate levels and the risk of IAI.
• Hyperlactatemia (>6 mmol/L) was independently associated with increased odds of developing IAI (OR=1.36; 95% CI, 1.08-1.70).
• Elevated lactate predicted 28-day ICU mortality in non-IAI patients, but this association was lost in the IAI cohort after adjustment.

Conclusions:

• Early blood lactate levels, particularly hyperlactatemia, are associated with an increased risk of ICU-acquired infections in sepsis patients.
• Lactate's prognostic value for mortality may differ between sepsis patients with and without IAI.
• Further research is warranted to explore lactate's role in IAI pathogenesis and its utility as a predictive biomarker.