Photo Credit: Liudmila Chernetska

The following is a summary of “Lactate combined with SOFA score for improving the predictive efficacy of SOFA score in patients with severe heatstroke,” published in the April 2024 issue of Emergency Medicine by Liu, et al.

The association between lactate levels and multiple organ dysfunction in patients with severe heatstroke remains uncertain. For a study, researchers sought to clarify the clinical significance of lactate in severe heatstroke prognosis and investigate whether incorporating lactate into the Sequential Organ Failure Assessment (SOFA) score enhances its predictive accuracy.

The multicenter retrospective cohort study included 275 patients. Logistic regression analysis assessed the relationship between lactate levels and patient outcomes, including acute kidney injury (AKI), disseminated intravascular coagulation (DIC), and myocardial injury. Receiver operating characteristic (ROC) curves and clinical decision curve analysis (DCA) evaluated the predictive performance of lactate and SOFA scores for severe heatstroke-related mortality. Kaplan–Meier survival curves differentiated survival rates among patient groups.

After adjusting for confounders, lactate emerged as an independent risk factor for death (OR = 1.353), AKI (OR = 1.158), DIC (OR = 1.426), and myocardial injury (OR = 2.039) in patients with severe heatstroke. The AUC of lactate for predicting severe heatstroke-related death was 0.7540, with a cutoff of 3.35. Kaplan–Meier survival analysis revealed higher mortality rates in patients with elevated lactate levels. ROC curves indicated that combining lactate with the SOFA score improved predictive efficacy compared to the SOFA score alone (AUC: 0.9025 vs. 0.8773, DeLong test, P < 0.001). Moreover, DCA demonstrated a higher net clinical benefit rate for lactate combined with the SOFA score.

Lactate served as an independent risk factor for severe heatstroke-related mortality, AKI, DIC, and myocardial injury. Combining lactate with the SOFA score significantly enhanced predictive accuracy in patients with severe heatstroke.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000342