ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1605319
This article is part of the Research TopicOutcome of Sepsis and Prediction of Mortality Risk - Volume IIView all 3 articles
Nonlinear association between lactate and 28-day mortality in elderly patients with sepsis across different SOFA score groups: Results from the eICU collaborative research database
Provisionally accepted
- 1Fuyong People's Hospital of Bao'an District, No. 81, Defeng Road, Fuyong Street,, China
- 2Empower U, X&Y solutions Inc., Boston, United States
- 3Shenzhen Children's Hospital, Shenzhen, China
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Purpose: This study aimed to examine the correlation between lactate levels and 28day mortality in elderly sepsis patients across different Sequential Organ Failure Assessment (SOFA) score groups following ICU admission. Methods: A multi-center retrospective cohort study utilized data from the eICU Collaborative Research Database, encompassing elderly sepsis patients from 208 ICUs across the United States during 2014-2015. Lactate levels and SOFA scores at admission were collected, with a focus on 28-day mortality post-ICU admission. A two-piece-wise linear regression model was developed to assess the threshold effects of lactate on outcomes and its variation across SOFA score categories. Smooth curve fitting was utilized. Results: Of the 5,150 patients with a median age of 76 years, 711 (13.8%) died within 28 days of ICU admission. A positive correlation was noted between lactate levels and mortality when lactate was <3.7mmol/l, with an adjusted odds ratio (OR) of 1.33 (95% CI: 1.17-1.51, P < 0.0001) for each increment in lactate. For lactate levels ≥3.7 mmol/L, mortality increased with an adjusted OR of 1.11 (95% CI: 1.05-1.18, P=0.0003) for each increment in lactate. Moreover, mortality was low and rose gradually with increasing lactate levels in the SOFA score ≤5 group. Conversely, in the SOFA score >5 group, mortality increased significantly, particularly when lactate levels exceeded 5 mmol/L.This study reveals a nonlinear positive relationship between lactate and 28-day mortality among elderly sepsis patients. Furthermore, stratification by SOFA score demonstrated that patients with higher scores exhibited a heightened risk of mortality as lactate levels increased.
Keywords: Lactate, Mortality, Elderly, Sepsis, SOFA score
Received: 03 Apr 2025; Accepted: 29 May 2025.
Copyright: © 2025 Zhang, Liu, Zhang, Deng, Chen and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Luyang Zhang, Shenzhen Children's Hospital, Shenzhen, China
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