title: Prognostic role of lactate on mortality in younger and older patients with cardio-respiratory failure admitted to an acute intensive care unit.
abstract: OBJECTIVE
  Acidosis is able to induce negative changes of different organs that increase progressively with aging. At present it is not known whether the levels of lactate may differently influence the prognosis of younger and older patients. Thus, the aim of this study is to evaluate the prognostic value of lactate levels after admission of younger and older patients to an acute intensive care unit.
  
  
  METHODS
  Younger (<65 years, n = 118) and older (≥65 years, n = 165) patients admitted to an acute intensive care unit were prospectively enrolled and classified according to diagnosis of acute heart or/and respiratory failure. For each patient, APACHE II score, time of hospitalization and mortality, blood levels of lactate were collected.
  
  
  RESULTS
  Both in-hospital mortality and lactate >2.5 mmol/L at the admission was higher in the older than in the younger patients (42.4 vs. 20.3 %, p < 0.01 and 57.8 vs. 31.9 %, p < 0.01, respectively). Lactate level was higher in older than in the younger patients both at admission and after 24 h (3.9 ± 3.4 vs. 2.4 ± 2.2 mmol/L and 2.4 ± 2.0 vs. 1.4 ± 1.3 mmol, p < 0.01, respectively). Accordingly, multivariate analysis shows that lactate was predictive of mortality in younger (OR = 2.65, 95 % CI 1.62-5.24, p = 0.03) and even more in the older (OR = 4.74, 95 % CI 2.10-6.70, p < 0.01) patients.
  
  
  CONCLUSIONS
  Lactate concentration increase is associated with increased mortality in younger patients but, even more so, in older patients admitted to an acute intensive care unit. These results confirm the experimental evidence showing acidosis has a greater effect of leading to organ failure and higher mortality with increasing age.
authors.affiliation: Intensive Geriatric Care Unit, Ospedale San Giuseppe Moscati, Avellino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: di Grezia
authors.affiliation: Intensive Geriatric Care Unit, Ospedale San Giuseppe Moscati, Avellino, Italy.
authors.forename: Emiliano Assante
authors.initials: EA
authors.lastname: di Panzillo
authors.affiliation: Intensive Geriatric Care Unit, Ospedale San Giuseppe Moscati, Avellino, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Russo
authors.affiliation: AON, SS Antonio e Biagio e Cesare Arrigo, Struttura Complessa di Geriatria, Alessandria, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Gargiulo
authors.affiliation: Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.|Department of Advanced Biotechnologies and Bioimaging, IRCCS San Raffaele, Rome, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Della-Morte
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Testa
authors.affiliation: IRCCS Salvatore Maugeri Foundation, Scientific Institute of Campoli/Telese, Benevento, Italy.|Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cacciatore
authors.affiliation: Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Bonaduce
authors.affiliation: Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy. p.abete@unina.it.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Abete
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood / Q000150:complications / Q000175:diagnosis; D054058:Acute Coronary Syndrome / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012131:Respiratory Insufficiency / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control
chemical_list: D019344:Lactic Acid
keywords: Elderly; Lactate; Mortality