SERUM LACTATE AND OUTCOME IN CRITICALLY ILL ELDERLY

Abstract

SUMMARY T he aim of the current study was to determine the relation between serum lactate level and outcome in critically ill elderly patients. The sample of our study consists of 90elderly patients 60 years and elder (both males and females) admitted to I.C.U for at least 24 hours. Theywere subdivided according to serum lactate level on admission into two groups: Group 1: Those with high serum lactate (admission lactate >2 mEq/l). Group 2:Those with normal serum lactate. Exclusion criteria: those who were admitted to I.C.U for less than 24 hours and those who refused to participate in our study. Each participant was subjected to: 1- Informed oral consent from the patient or care giver of cognitively non-competent participant 2- Full medical history. 3- Medical examination including level of consciousness, initial vital data on admission and body mass index. 4- Laboratory finding including CBC, bleeding profile, kidney function test, liver function test, albumin and arterial blood gases. 5- Serum lactate on admission and after six hours and lactate clearance was calculated. 6- Acute Physiology and Chronic Health Evaluation (APACHE II) score upon admission (Kanus et al., 1985) as an ICU scoring system The results of our study showed that the prevalence of hyperlactatemia on admission to ICU was 61 %. The rate of mortality among our study participants was 43%. In the current study we found that mortality was associated with respiratory rate, heart rate, history of ischemic heart disease, the conscious level as measured by GCS, need of mechanical ventilation, the length of ICU stay, APCHE -II score on admission, serum lactate after 6 hours from admission and lactate clearance. The results of our study showed that initial serum lactate (on admission) has no significant statistical effect on outcome in elderly admitted in ICU in contrast to follow up serum lactate after six hours and lactate clearance .