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. 2021 Sep 15;13(9):10363-10371.
eCollection 2021.

Serum lactate concentration on admission to hospital predicts the postoperative mortality of elderly patients with hip fractures 30 days after surgery

Xiaobin Chen  1   2 , Jianzheng Zhang  2 , Yang Zhang  2 , Yiyun Lin  2 , Zhi Liu  2 , Xiaowei Wang  2 , Tiansheng Sun  2
Affiliations

Serum lactate concentration on admission to hospital predicts the postoperative mortality of elderly patients with hip fractures 30 days after surgery

Xiaobin Chen et al. Am J Transl Res. .

Abstract

Purpose: To determine whether serum lactate concentration on admission to hospital is a predictor for 30-day and 1-year mortality for patients who underwent hip-surgery.

Methods: Data from elderly patients with hip fractures admitted to our hospital (Jan 2012-Dec 2016) were reviewed. The lactate concentration on admission was assessed using a cut-off value of 2.0 mmol/L and then a new cut-off value was determined by maximizing the Youden index. Multivariate logistic regression was employed to verify whether a higher lactate concentration compared with the cutoff value was an independent risk factor for postoperative mortality after 30 days or at 1 year.

Results: A total of 1,004 patients were enrolled. There were differences in the incidence of postoperative complications (28.6% vs. 21.9%, P=0.022), length of stay (13.56±8.66 vs. 12.47±7.81 days, P=0.047), 30-day mortality (10.8% vs. 1.3%, P<0.001), 1-year mortality (23.3% vs. 11.8%, P<0.001) and survival time (23.92±16.58 vs. 28.81±16.54 months, P<0.001) between the ≥2.0 mmol/L (n=315) and <2 mmol/L (n=689) groups. Serum lactate concentration was a good predictor of 30-day mortality (AUC=0.829, P<0.001) with a cutoff value of lactate =2.35 mmol/L (sensitivity =0.744, specificity =0.834). Multivariate analysis revealed that a serum lactate concentration ≥2.35 mmol/L at admission was an independent risk factor for 30-day (OR=9.93, P<0.001) and 1-year (OR=2.23, P<0.001) mortality.

Conclusion: The admission lactate concentration (≥2.35 mmol/L) following hip fracture derived by this study was a significant predictor of mortality 30 days after surgery, which might help physicians to stratify the risk for these patients.

Keywords: 30-day mortality; Hip fracture; elderly; lactate concentration; predictor.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
A. 30-day mortality and 1-year mortality; B. Kaplan-Meier survivorship curves of elderly hip fracture patients with lactate concentrations ≥2 mmol/L and those with lactate concentrations <2 mmol/L.
Figure 2
Figure 2
ROC curves of the predictive model of (A) 30-day mortality (AUC: 0.829) and (B) 1-year mortality (AUC: 0.651) in elderly patients with hip fractures.
See this image and copyright information in PMC

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