CAN OUTCOMES IN PATIENTS WITH COVID-19 PNEUMONIA AND ACUTE RESPIRATORY BE PREDICTED WITH ADMISSION SERUM LACTIC ACID LEVELS?

Abstract

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Within the last year, Coronavirus-19 (COVID-19) has been observed to cause extensive multi-system complications including death and has become a challenge for health care providers. Lactic acid is a biomarker that accumulates when the body has increased anaerobic production or decreased clearance. It has been used to predict mortality in acute illnesses causing multiorgan failure secondary to hypoxia and hypoperfusion. In patients infected with COVID-19, a known complication is cytokine storm due to a dysregulated inflammatory response leading to refractory hypoxemia, lactic acidosis and acute respiratory distress syndrome (ARDS). The objective of this study was to determine if admission lactic acid levels correlated with outcomes including hospital length of stay (LOS), intensive care unit (ICU) LOS and mortality in patients with acute respiratory failure due to COVID-19 pneumonia. METHODS: One-hundred and five (105) patients, admitted for acute respiratory failure due to COVID-19, were retrospectively studied. Patient demographics including patient age, gender, ICU LOS, hospital LOS, admission serum lactic acid levels, and mortality were obtained through reviewing medical records. Statistical analysis to determine the correlation between admission lactic acid levels, hospital LOS, ICU LOS and mortality was performed using Pearson’s correlation with a p ≤0.05 being statistically significant. Independent t-test was used to determine impact of admission serum lactic acid levels on mortality. RESULTS: Of the 105 patients studied, 84 patients had an admission lactic acid level. Of these 84 patients, 70% were male, and the mean age was 65.65 ± 16.05 years. Pearson’s correlation analysis revealed significant correlation between admission lactic acid levels and mortality (r = -0.265;p = 0.01). The mean admission lactic acid level was 2.3 ± 2.2 mmol/L in non-survivors compared to 1.4 ±1.1 mmol/L in survivors (p = 0.01, independent t-test). However, there was no statistically significant correlation between admission lactic acid levels and hospital LOS (r= 0.03, p = 0.77) or ICU LOS (r=0.1, p = 0.34). CONCLUSIONS: The study demonstrated a significant correlation between admission lactic acid levels and mortality in patients with acute respiratory failure due to COVID-19 pneumonia, but not with lCU or hospital length of stay. The mean lactic acid levels on admission were also higher in non-survivors. CLINICAL IMPLICATIONS: Admission lactic acid levels might help in triaging and prognostication patients with acute respiratory failure due to COVID-19 pneumonia. Patients with higher lactic acid levels might be better managed in units with closer monitoring and intensive care. Further studies may also outline if there is a specific serum lactic acid level that correlates with the increased mortality risk in patients with acute respiratory failure due to COVID-19. DISCLOSURES: No relevant relationships by Debapriya Datta, source=Web Response No relevant relationships by Manasvi Gupta, source=Web Response No relevant relationships by Gaurav Manek, source=Web Response No relevant relationships by Suong Nguyen, source=Web Response