The association between lactate trajectories and prognosis in ICU patients with pneumonia: A retrospective group-based trajectory model analysis
Abstract
Objective To identify pneumonia-specific lactate trajectory phenotypes and evaluate their association with 28-day mortality in ICU patients with pneumonia. Methods A retrospective cohort study was performed using the MIMIC-IV database. Adult ICU patients with pneumonia were identified via ICD-9/10 codes. Exclusions were non-index ICU admissions, age 100 years, ICU stay <3 days, and incomplete lactate data in the first 72 hours. Demographics, vital signs, laboratory results, comorbidities, severity scores, and treatments were extracted. Group-based trajectory modeling (GBTM) was applied to lactate values over 72 hours. Model selection considered BIC, AIC, average posterior probability (AvePP), odds of correct classification (OCC), class size, and clinical interpretability. Outcomes included 28-day all-cause mortality (primary) and secondary endpoints. Kaplan-Meier analysis and Cox regression were used to examine associations, with subgroup analyses across demographic and clinical strata. Results A total of 2,091 patients were included. Four distinct lactate trajectories were identified: low-stable (n=1161), moderate with gradual decline (n=721), initial rise then decline (n=89), and very high with rapid decline (n=120). Unfavorable trajectory classes were associated with greater illness severity, metabolic derangements, resource use, and higher mortality. As a continuous variable, lactate showed a borderline association with 28-day mortality in unadjusted analysis (HR 1.03,…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,091 participants or records.
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