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Incidence of Hyperlactatemia in Critically Ill Cancer Patients FREE TO VIEW

Silvio Namendys-Silva, MS; Paulina Correa-García; Francisco J. García-Guillén; Yves D. Jarquín-Badiola; Julia Texcocano-Becerra; Gonzalo Montalvo-Esquivel; Angel Herrera-Gómez; Erika B. Ruiz-García; Abelardo Meneses-García
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Department of Critical Care Medicine, Instituto Nacional de Cancerología, México, Mexico City, Mexico City, Mexico

Chest. 2014;146(4_MeetingAbstracts):518A. doi:10.1378/chest.1991913
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SESSION TITLE: Outcomes/Quality Control Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: This study was designed to describe the incidence of hyperlactatemia, clinical characteristics, and intensive care unit (ICU) outcomes of critically ill cancer patients admitted to an oncological ICU.

METHODS: The present study was an observational and descriptive study that included 173 critically ill cancer patients admitted to the ICU of the Instituto Nacional de Cancerologia, Mexico between February 2013 and December 2013. The discriminative ability of serum lactate to predict death in the ICU was assessed by calculating the area under receiver operating characteristic curve (AUCROC). Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. A two-sided P value <0.05 was used to determine statistical significance.

RESULTS: Of 173 patients included in the study, 53.7% had hyperlactatemia on admission to the ICU. In the group of patients with hyperlactatemia the ICU mortality was 27.9 %. The lactate level at 24 hours had better discriminative ability to predict death in the ICU. A lactate level greater than 2.2 mmol / L had a sensitivity of 57.7% and specificity of 75.9% to predict death in the ICU. The AUCROC for the serum level of lactate at admission and after 24 hours in the ICU were 0.59 (95% CI: 0.49 to 0.69), and 0.66 (95% CI: 0.55 to 0.76) (p = 0.036), respectively. In this study, 80.9 % of patients had a 10% higher clearance, but no statistically significant difference was found when comparing patients who died and those who lived (85 % versus 79 %, p = 0.454). The mortality in the ICU was 23.1 %. In the multivariate analysis, hemoglobin < 9.8 g / dL, platelets < 44 ( 103/μL ), serum albumin < 1.48 mg / dL measured on discharge from ICU and serum lactate levels > 2.2 mmol / L after 24 hours in the ICU were independent predictors of death in the ICU.

CONCLUSIONS: The incidence of hyperlactatemia in critically ill cancer patients is high. The serum level of lactate 24 hours after admission to the ICU showed good discrimination for predicting mortality in the ICU. Independent predictors of death in the ICU were: hemoglobin < 9.8 g / dL, platelets < 44 ( 103/μL ), serum albumin < 1.48 mg / dL measured on discharge from ICU and serum lactate levels > 2.2 mmol / L after 24 hours in the ICU.

CLINICAL IMPLICATIONS: Our findings suggest that lactate measurement should be included in the routine assessment of patients with cancer who are admitted to the ICU.

DISCLOSURE: The following authors have nothing to disclose: Silvio Namendys-Silva, Paulina Correa-García, Francisco J. García-Guillén, Yves D. Jarquín-Badiola, Julia Texcocano-Becerra, Gonzalo Montalvo-Esquivel, Angel Herrera-Gómez, Erika B. Ruiz-García, Abelardo Meneses-García

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