Lactate combined with SOFA score for improving the predictive efficacy of SOFA score in patients with severe heatstroke

• Published in: The American journal of emergency medicine 2024-04, Vol.78, p.163-169
• Main Authors: Liu, Fujing, Jin, Fang, Zhang, Lingling, Tang, Yun, Wang, Jinhai, Zhang, He, Gu, Tijun
• Format: Article
• Language: English
• Subjects: Blood pressure; Cardiovascular disease; Chronic illnesses; Chronic obstructive pulmonary disease; Coma; Confounding (Statistics); Death; Disseminated intravascular coagulation; Emergency medical care; Heart; Heatstroke; Hospitalization; Hospitals; Kidneys; Lactate; Lactic acid; Medical prognosis; Medical records; Metabolism; Metabolites; Mortality; Nervous system; Patients; Prognosis; Regression analysis; Risk factors; Sensitivity analysis; Severe heatstroke; SOFA score; Survival; Temperature
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2024.01.033

The relationship between lactate levels and multiple organ dysfunction in patients with severe heatstroke remains unclear. In this study, we aimed to elucidate the clinical significance of lactate in severe heatstroke prognosis and assess whether incorporating lactate in the SOFA score improves its predictive efficacy. This study was a multicenter retrospective cohort investigation included 275 patients. Logistic regression analysis was performed to examine the relationship between lactate levels and patient outcomes and complications, including acute kidney injury (AKI), disseminated intravascular coagulation (DIC), and myocardial injury. Further, receiver operating characteristic (ROC) curves and clinical decision curve analysis (DCA) were used to evaluate the predictive power of lactate and SOFA scores in severe heatstroke-associated death. Lastly, the Kaplan–Meier survival curve was employed to differentiate the survival rates among the various patient groups. After adjusting for confounding factors, lactate was demonstrated as an independent risk factor for death (OR = 1.353, 95% CI [1.170, 1.569]), AKI (OR = 1.158, 95% CI [1.007, 1.332]), DIC (OR = 1.426, 95% CI [1.225, 1.659]), and myocardial injury (OR = 2.039, 95% CI [1.553, 2.679]). The area under the curve (AUC) of lactate for predicting death from severe heatstroke was 0.7540, with a cutoff of 3.35. The Kaplan–Meier survival curve analysis showed that patients with elevated lactate levels had higher mortality rates. Additionally, the ROC curves demonstrated that combining lactate with the SOFA score provided better predictive efficacy than the SOFA score alone in patients with severe heatstroke (AUC: 0.9025 vs. 0.8773, DeLong test, P