Early lactate trajectories predict mortality in sepsis-associated acute lung injury: A retrospective cohort study - 17/11/25
Abstract |
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Three distinct lactate trajectories were identified in sepsis-associated acute lung injury. |
• | The persistently high-lactate group showed the highest 28-day mortality. |
• | Integrating lactate trajectories into SOFA improved prognostic performance (AUC 0.693). |
• | Decision curve analysis confirmed greater clinical net benefit of the combined model. |
• | Lactate trajectories provide a dynamic biomarker for individualized ICU risk assessment. |
Keywords : Sepsis-associated acute lung injury, Lactate trajectory, Intensive care unit, Mortality prediction, Latent class modeling, SOFA score
Plan
Vol 249
Article 108471- novembre 2025 Retour au numéro
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