Course of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients

Course of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Course of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients Anja Schork, Kathrin Moll, Michael Haap, Reimer Riessen, Robert Wagner This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-484036/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Dec, 2021 Read the published version in PLOS ONE → Version 1 posted You are reading this latest preprint version Abstract Introduction : As base excess (BE) had shown superiority over lactate as a prognostic parameter in intensive care unit (ICU) surgical patients we aimed to evaluate course of lactate, base excess and pH for prediction of mortality of medical ICU patients. Materials and Methods : For lactate, pH and base excess, values at the admission to ICU, at 24 ± 4 hours, maximum / minimum in the first 24 hours and in 24 – 48 hours after admission were collected from all patients admitted to the Medical ICU of the University Hospital Tübingen between January 2016 until December 2018 and investigated for prediction of in-hospital-mortality. Results : Mortality in the cohort of 4067 patients was 22 % and significantly correlated with all evaluated parameters. Strongest predictors of mortality determined by ROC were maximum lactate in 24 h (AUROC 0.74, cut off 2.7 mmol/L, hazard ratio of risk group with value > cut off 3.20) and minimum pH in 24 h (AUROC 0.71, cut off 7.31, hazard ratio for risk group 2.94). Kaplan Meier Curves stratified across these cut offs showed early and clear separation. Hazard ratios per standard deviation increase were highest for maximum lactate in 24 h (HR 1.65), minimum base excess in 24 h (HR 1.56) and minimum pH in 24 h (HR 0.75). In multiple logistic regression analysis, age, minimum pH in 24 h, pH at 24 h after admission, maximum lactate in 24 h, maximum lactate in 24 – 48 h, minimum base excess in 24 h and minimum base excess in 24 – 48 h were independent predictors of mortality. Discussion : Lactate, pH and base excess were all suitable predictors of mortality in internal ICU patients, with maximum / minimum values in 24 and 24-48 h after admission altogether stronger predictors than values at admission. Base excess and pH were not superior to lactate for prediction of mortality. Health Economics & Outcomes Research Health Policy Internal Medicine Medical Genetics Lactate pH base excess clearance medical ICU mortality Figures Figure 1 Figure 2 Figure 3 Figure 4 Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 20 Dec, 2021 Read the published version in PLOS ONE → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-484036","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":29787277,"identity":"80282127-233b-4ae6-85d2-3163ba60fe81","order_by":0,"name":"Anja Schork","email":"data:image/png;base64,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","orcid":"","institution":"University Hospital Tübingen","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Anja","middleName":"","lastName":"Schork","suffix":""},{"id":29787278,"identity":"0898ca57-6484-42ae-8be2-711d414f0591","order_by":1,"name":"Kathrin Moll","email":"","orcid":"","institution":"University Hospital Tübingen","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kathrin","middleName":"","lastName":"Moll","suffix":""},{"id":29787279,"identity":"1afa969a-488a-4fc7-bf96-897f09181462","order_by":2,"name":"Michael Haap","email":"","orcid":"","institution":"University Hospital Tübingen","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Haap","suffix":""},{"id":29787280,"identity":"228522ba-d921-483b-a9fc-77fac0fa38ae","order_by":3,"name":"Reimer Riessen","email":"","orcid":"","institution":"University Hospital Tübingen","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Reimer","middleName":"","lastName":"Riessen","suffix":""},{"id":29787281,"identity":"bb75042d-5a4b-4f30-86e8-291842a7fe6d","order_by":4,"name":"Robert Wagner","email":"","orcid":"","institution":"University Hospital Tübingen","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Wagner","suffix":""}],"badges":[],"createdAt":"2021-05-01 11:44:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-484036/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-484036/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1371/journal.pone.0261564","type":"published","date":"2021-12-20T19:47:49+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":9842289,"identity":"6ae90778-fd57-4d06-b16a-529f132a56ee","added_by":"auto","created_at":"2021-06-01 17:57:55","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":93544,"visible":true,"origin":"","legend":"Flow chart study cohort and evaluated parameters","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-484036/v1/57d2249545da6d274dc7f05a.jpg"},{"id":9842288,"identity":"373725fc-3482-4245-bdc4-4cda891f6663","added_by":"auto","created_at":"2021-06-01 17:57:55","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":45221,"visible":true,"origin":"","legend":"Distribution of patients (A) and Kaplan Meier curves (B) by primary diagnosis group","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-484036/v1/a75187ab51ed31962638e0f9.jpg"},{"id":9842616,"identity":"a23d7d01-169f-444a-99f3-cf548a1b6fe7","added_by":"auto","created_at":"2021-06-01 18:00:55","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":71953,"visible":true,"origin":"","legend":"ROC analysis of mortality by maximum lactate (A) and minimum pH (B) in the first 24 h after admission, and multivariable ROC of mortality (C)","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-484036/v1/f4141b601ca603f999071deb.jpg"},{"id":9842617,"identity":"5ee427c5-e25b-4fc0-8a72-a9cf7faef23b","added_by":"auto","created_at":"2021-06-01 18:00:55","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":63879,"visible":true,"origin":"","legend":"Kaplan Meier curve of mortality by maximum lactate (A), minimum base excess (B) and minimum pH (C) in the first 24 h after admission\nCut off values used for stratification in risk groups were determined by ROC analysis.\nAbbreviations: Lac, lactate; BE, base excess.","description":"","filename":"fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-484036/v1/041fd3c6830633761b56ceff.jpg"},{"id":16629809,"identity":"35c52180-1c9e-4456-a866-28ef15e3b879","added_by":"auto","created_at":"2021-12-20 19:48:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":847592,"visible":true,"origin":"","legend":"","description":"","filename":"manuscriptICUBGAandMortalityScientRep.pdf","url":"https://assets-eu.researchsquare.com/files/rs-484036/v1_covered.pdf"},{"id":13637451,"identity":"08681508-f4e5-42fe-a071-764dad344a7b","added_by":"auto","created_at":"2021-09-17 08:45:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":842452,"visible":true,"origin":"","legend":"","description":"","filename":"manuscriptICUBGAandMortalityScientRep.pdf","url":"https://assets-eu.researchsquare.com/files/rs-484036/v1_covered.pdf"},{"id":9842619,"identity":"728bf8a7-db98-4176-8eb1-592ca80bf737","added_by":"auto","created_at":"2021-06-01 18:01:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":838946,"visible":true,"origin":"","legend":"","description":"","filename":"manuscriptICUBGAandMortalityScientRep.pdf","url":"https://assets-eu.researchsquare.com/files/rs-484036/v1_covered.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCourse of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients\u003c/p\u003e","fulltext":[{"header":"Full Text","content":"This preprint is available for \u003ca href='/article/rs-484036/latest.pdf' target='_blank'\u003edownload as a PDF\u003c/a\u003e."}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lactate, pH, base excess, clearance, medical ICU, mortality","lastPublishedDoi":"10.21203/rs.3.rs-484036/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-484036/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: As base excess (BE) had shown superiority over lactate as a prognostic parameter in intensive care unit (ICU) surgical patients we aimed to evaluate course of lactate, base excess and pH for prediction of mortality of medical ICU patients. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMaterials and Methods\u003c/strong\u003e: For lactate, pH and base excess, values at the admission to ICU, at 24 ± 4 hours, maximum / minimum in the first 24 hours and in 24 – 48 hours after admission were collected from all patients admitted to the Medical ICU of the University Hospital Tübingen between January 2016 until December 2018 and investigated for prediction of in-hospital-mortality. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Mortality in the cohort of 4067 patients was 22 % and significantly correlated with all evaluated parameters. Strongest predictors of mortality determined by ROC were maximum lactate in 24 h (AUROC 0.74, cut off 2.7 mmol/L, hazard ratio of risk group with value \u0026gt; cut off 3.20) and minimum pH in 24 h (AUROC 0.71, cut off 7.31, hazard ratio for risk group 2.94). Kaplan Meier Curves stratified across these cut offs showed early and clear separation. Hazard ratios per standard deviation increase were highest for maximum lactate in 24 h (HR 1.65), minimum base excess in 24 h (HR 1.56) and minimum pH in 24 h (HR 0.75). In multiple logistic regression analysis, age, minimum pH in 24 h, pH at 24 h after admission, maximum lactate in 24 h, maximum lactate in 24 – 48 h, minimum base excess in 24 h and minimum base excess in 24 – 48 h were independent predictors of mortality. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e: Lactate, pH and base excess were all suitable predictors of mortality in internal ICU patients, with maximum / minimum values in 24 and 24-48 h after admission altogether stronger predictors than values at admission. Base excess and pH were not superior to lactate for prediction of mortality.\u003c/p\u003e","manuscriptTitle":"Course of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-06-01 17:57:53","doi":"10.21203/rs.3.rs-484036/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2cab20c4-2781-4280-9595-91fc3a7979b4","owner":[],"postedDate":"June 1st, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":4666954,"name":"Health Economics \u0026 Outcomes Research"},{"id":4666955,"name":"Health Policy"},{"id":4666956,"name":"Internal Medicine"},{"id":4666957,"name":"Medical Genetics"}],"tags":[],"updatedAt":"2021-12-20T19:47:49+00:00","versionOfRecord":{"articleIdentity":"rs-484036","link":"https://doi.org/10.1371/journal.pone.0261564","journal":{"identity":"plos-one","isVorOnly":true,"title":"PLOS ONE"},"publishedOn":"2021-12-20 19:47:49","publishedOnDateReadable":"December 20th, 2021"},"versionCreatedAt":"2021-06-01 17:57:53","video":"","vorDoi":"10.1371/journal.pone.0261564","vorDoiUrl":"https://doi.org/10.1371/journal.pone.0261564","workflowStages":[]},"version":"v1","identity":"rs-484036","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-484036","identity":"rs-484036","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}