The association between lactate level of first day in hospital and 14-day mortality in ischemic stroke patients a study based on the MIMIC-IV database

Background Ischemic stroke is a leading cause of death and disability worldwide, and early prognostic assessment is crucial for optimizing patient management. Lactate is an important biomarker reflecting tissue hypoxia and metabolic disorders, and its relationship with short-term mortality risk has not been fully clarified. This study aimed to explore the association between early lactate levels on admission and the risk of mortality within 14 days in patients with ischemic stroke. Methods This study was a retrospective cohort study based on the MIMIC-IV database. Cases with high-risk underlying diseases such as hypertension and diabetes were excluded. Univariate and multivariate logistic regression analysis was used to evaluate the relationship between lactate level and short-term mortality risk, and the ROC curve was used to analyze the predictive ability of lactate and other biochemical indicators. In addition, subgroup analysis was performed to explore the interaction of biochemical indicators in patient groups with different mortality risks. Results A total of 157 patients with ischemic stroke were included, including 107 in the survival group and 50 in the death group. Univariate analysis showed that lactate level was significantly associated with 14-day mortality (P < 0.05), but multivariate regression analysis revealed that lactate level was not an independent risk factor (P < 0.05). Potassium and sodium ion levels were independent risk factors for short-term mortality (P < 0.05). ROC analysis showed that the AUC of lactate, potassium and sodium ions were between 0.60 and 0.70, indicating limited predictive ability. Subgroup analysis found that lactate was associated with sodium, chloride and blood glucose levels in the survival group, while lactate was associated with calcium, sodium and chloride ions in the non-survival group, suggesting different mechanisms of lactate and electrolyte metabolism in different populations. Conclusion Lactate level has certain clinical value in the short-term prognosis assessment of ischemic stroke patients, but its independence is limited; Potassium and sodium ion level is an important independent risk factor. Lactate and electrolyte metabolism may be different in different subgroups.