DataSheet_1_Outcomes of hyperlactatemia on admission in critically ill patients with acute myocardial infarction: A retrospective study from MIMIC-IV.docx

BackgroundIt has not been verified whether there is a correlation between admission hyperlactatemia and outcomes in critically ill patients with acute myocardial infarction (AMI), especially in large data studies, which we aimed to do in this study.
MethodsFor this retrospective study, we extracted analysis data from a famous online intensive care unit database, the Medical Information Mart for Intensive Care (MIMIC)-IV. Included patients were divided into four groups according to the serum lactate level on admission. Hospital mortality and mortality over time were the main outcomes. To explore the relationship between admission hyperlactatemia and outcomes in critically ill patients with AMI, logistic regression, Cox regression, Kaplan-Meier curves, and subgroup analyses were used.
Results2171 patients matching the selection criteria were enrolled in this study. After adjusting for potential confounding factors, hyperlactatemia on admission contributed to increased short-term mortality in critically ill patients with AMI. The adjusted odds ratio for hospital mortality were 1.62, 3.46 and 5.28 in the mild, moderate, and severe hyperlactatemia groups (95% CI: 1.20-2.18, 2.15-5.58, and 2.20-12.70, respectively). The adjusted hazard ratio for 7-day and 30-day mortality were 1.99 and 1.35 (95% CI: 1.45-2.73 and 1.09-1.67) in the mild hyperlactatemia group, 3.33 and 2.31 (95% CI: 2.22-4.99 and 1.72-3.10) in the moderate hyperlactatemia group, 4.81 and 2.91 (95% CI: 2.86-8.08 and 1.88-4.50) in the severe hyperlactatemia group. The adjusted hazard ratio for 1-year and 5-year mortality were 2.03 and 1.93 (95% CI: 1.58-2.62 and 1.52-2.47) in the moderate hyperlactatemia group, 1.92 and 1.74 (95% CI: 1.28-2.89 and 1.17-2.59) in the severe hyperlactatemia group. Subgroup analyses indicated that the positive correlation between serum lactate level on admission and short-term mortality of critically ill patients with AMI was similar in the subgroups of cardiogenic shock and acute heart failure (P for interaction > 0.05).
ConclusionHyperlactatemia, especially moderate and severe hyperlactatemia, on admission is closely related to higher short-term mortality incidence in critically ill patients with AMI. The relationship between serum lactate level on admission and short-term mortality of critical AMI patients is stable in subgroups of cardiogenic shock and acute heart failure.

背景 目前尚未明确急性心肌梗死（acute myocardial infarction, AMI）重症患者入院时高乳酸血症（hyperlactatemia）与预后之间的相关性，现有大型数据研究对此尚无定论，本研究即旨在开展此类探究。
方法 本研究为回顾性研究，数据提取自知名在线重症监护数据库——重症监护医学信息数据库（Medical Information Mart for Intensive Care, MIMIC-IV）。研究对象根据入院时血清乳酸水平分为四组，主要预后终点为住院死亡率及随时间变化的死亡率。为探究急性心肌梗死重症患者入院高乳酸血症与预后的关联，本研究采用逻辑回归（logistic regression）、Cox回归（Cox regression）、Kaplan-Meier曲线（Kaplan-Meier curves）及亚组分析（subgroup analyses）进行数据分析。
结果 本研究共纳入2171名符合入选标准的患者。在校正潜在混杂因素后，入院时的高乳酸血症可增加急性心肌梗死重症患者的短期死亡风险。轻度、中度及重度高乳酸血症组患者的住院死亡率校正比值比（odds ratio）分别为1.62、3.46和5.28（95%置信区间（confidence interval, CI）：1.20~2.18、2.15~5.58及2.20~12.70）。轻度高乳酸血症组患者7天及30天死亡率的校正风险比（hazard ratio）分别为1.99和1.35（95%置信区间：1.45~2.73及1.09~1.67），中度高乳酸血症组分别为3.33和2.31（95%置信区间：2.22~4.99及1.72~3.10），重度高乳酸血症组分别为4.81和2.91（95%置信区间：2.86~8.08及1.88~4.50）。中度高乳酸血症组患者1年及5年死亡率的校正风险比分别为2.03和1.93（95%置信区间：1.58~2.62及1.52~2.47），重度高乳酸血症组分别为1.92和1.74（95%置信区间：1.28~2.89及1.17~2.59）。亚组分析显示，在心源性休克（cardiogenic shock）及急性心力衰竭（acute heart failure）亚组中，入院血清乳酸水平与急性心肌梗死重症患者短期死亡率的正相关关系保持一致（交互作用P>0.05）。
结论 急性心肌梗死重症患者入院时的高乳酸血症，尤其是中重度高乳酸血症，与更高的短期死亡率发生率密切相关。在心源性休克及急性心力衰竭亚组中，入院血清乳酸水平与急性心肌梗死重症患者短期死亡率的关联保持稳定。