Nutritional Status-Based Model for Predicting Low-Lactate Shock: A Retrospective Cohort Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Although Sepsis-3.0 defines septic shock as hypotension with serum lactate levels >2.0 mmol/L, this criterion may miss low-lactate shock: a clinically significant phenotype characterized by hypotension but without elevated lactate levels. The epidemiological characteristics and prognostic significance of low-lactate shock remain unclear, highlighting a critical gap in current shock management models. METHODS: We conducted a retrospective cohort study of 3,134 patients with shock admitted to a tertiary care medical institution from January 2015 to March 2022. We used propensity score matching (1:2 ratio) to control for confounding factors, aiming to determine the prevalence of low-lactate shock (lactate ≤ 2.0 mmol/L), identify risk factors through multivariable logistic regression, and validate the predictive model [Nutritional Risk Screening-2002-Acute Physiology and Chronic Health Evaluation-Triglycerides-Total Bilirubin (NRS-APACHE II-TG-TBIL)] using receiver operating characteristic analysis. RESULTS: The 28-day mortality rate was slightly lower in the low-lactate shock group compared with the high-lactate group [25.4% (94/369) vs. 35.8% (990/2,765), respectively]. The age, Nutritional Risk Screening-2002 (NRS-2002) score, and venous thromboembolism risk score were significantly lower in the low-lactate shock group than in the high-lactate shock group ( P < 0.05). No statistically significant differences were observed in gender distribution ( P = 0.092). Multivariable analysis identified four independent predictors of low-lactate shock: NRS-2002 [odds ratio (OR) = 0.570, P < 0.001], Acute Physiology and Chronic Health Evaluation II (APACHE II) (OR = 0.869, P < 0.001), triglycerides (OR = 0.772, P = 0.035), and total bilirubin (OR = 0.993, P = 0.002). The composite NRS-APACHE II-TG-TBIL model showed excellent discrimination (area under curve = 0.800, P < 0.001) with balanced sensitivity (72.6%) and specificity (73.5%). CONCLUSIONS: Low-lactate shock carries substantial mortality risk (25.4%). The validated NRS-APACHE II-TG-TBIL model (area under curve = 0.800) provides an effective tool for early detection, addressing critical diagnostic gaps in shock management.
Source: Shock
Authors: Xiaofang Xu, Fang Hu, Zhaocai Zhang
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4414430519