Predictive value of arterial blood lactic acid concentration on the risk of all-cause death within 28 days of admission in patients with severe acute pancreatitis

ABSTRACT

Objective

To evaluate the ability of arterial blood lactic acid concentration to predict death within 28 days of admission of patients with severe acute pancreatitis (SAP) in the intensive care unit (ICU).

Methods

Clinical data of 523 SAP patients in the MIMIC-IV database were retrospectively analyzed. Patients were divided into those who survived (n = 461) and those who died (n = 62) within 28 days of admission. The association between lactic acid concentration and all-cause death in SAP patients was determined by Cox regression analysis, Kaplan-Meier survival analysis and subgroup analysis. The ability of lactic acid concentration to predict the risk of all-cause death in SAP patients was determined by time-dependent receiver operating curve (ROC) analysis.

Results

Arterial blood lactic acid concentration was significantly higher in the 62 patients who died within 28 days than in the 461 patients who survived (P < 0.05). Adjusted multivariate Cox regression analysis showed that lactic acid concentration was a significant independent predictor on all-cause mortality within 28 days of admission for SAP (hazard ratio = 1.22, 95% confidence interval 1.09–1.36, P < 0.001), as did time-dependent ROC analysis (area under the ROC curve = 0.741). Kaplan-Meier analysis showed that the rate of all-cause mortality within 28 days of admission was significantly higher in patients with high than low lactic acid concentration (P < 0.0001). Subgroup analysis showed that there was no significant interaction between lactic acid concentration and other factors with all-cause death within 28 days of admission (all P > 0.05).

Conclusion

Arterial blood lactic acid concentration is an important independent predictor of all-cause mortality within 28 days of admission of SAP patients in the ICU.

KEYWORDS:

• Lactic acid
• acute severe pancreatitis
• intensive care unit
• 28 days
• prognosis

Author contributions

Menghuan Wu and Wei Zhang contributed to hypothesis development and manuscript preparation; Liang Shi and Hao Zhang were responsible for collecting blood samples and clinical data of participants. Hanqiong Liu and Yanru Liu conceived, designed, and performed the experiments. The version submitted for publication was authorized by all authors.

Disclosure of financial/other conflicts of interest

The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

The data used in this study are available by reasonable request to the corresponding author, as well as in PhysioNet (https://physionet.org/content/mimiciv/0.4/).

Additional information

Funding

This work was supported by a grant from the National Natural Science Foundation of China to Liang Shi [grant number: 82001865].