Evaluation of Lactate Levels and Standard Base Excess in the Prognosis of Critically Ill Patients: An Observational Study

Background: Elevated lactate levels, along with acidosis, adversely affect patient outcomes and are associated with high mortality.Evidence suggests that mortality is reduced significantly when these levels are corrected within the first 24 hours.Hence, this study aims to determine the effect of a change in base excess (BE) and lactate clearance in the first 24 hours on the clinical outcome of critically ill patients admitted to the ICU.Materials and methods: This is a retrospective review of arterial blood gas (ABG) analysis results of 54 critically ill patients admitted to the ICU.Lactate and standard BE levels were noted at admission and 24 hours after admission.Patients were divided into survivors and nonsurvivors.The mean and median were compared using a t-test.Kaplan-Meier survival analysis was performed for all patients regarding changes within the first 24 hours.Survivors were stratified according to the change in levels within 24 hours and correlated with the duration of hospital stay.Results: This study group had an overall mortality rate of 40%.A 24-hour change in lactate and standard base excess (SBE) showed a strong association with mortality.Persistent metabolic derangement at 24 hours correlated with decreased survival (p = 0.001 for SBE, p = 0.033 for lactate).Notably, all patients who achieved normal SBE within the first 24 hours survived.Additionally, 24-hour lactate clearance was significantly associated with shorter ICU stays (p = 0.01). Conclusion:This study suggests that 24-hour trends in lactate and SBE are stronger predictors of ICU mortality than initial values.Prompt care and treatment to control these metabolic derangements in the first few hours of admission can greatly increase the survival probability of the patient as well as reduce morbidity.