Higher Lactate Levels Increased Risk Of 28-Day Mortality In Patients With Paralytic Intestinal Obstruction: A Retrospective Data Analysis Based On MIMIC-Ⅳ Database

Introduction: The aim of this study was to investigate the relationship between serum lactate and clinical outcomes in patients with paralytic intestinal obstruction based on data from the MIMIC-IV database. Currently, elevated serum lactate levels have been reported to be associated with mortality in diseases such as sepsis and liver failure. However, there is a lack of evidence on the relationship between lactate and paralytic bowel obstruction, therefore, the aim of this paper is to investigate the relationship between lactate and 28-day mortality in patients with paralytic bowel obstruction. Methods: This was a single-center retrospective study. Based on specific screening criteria, 1472 patients with paralytic bowel obstruction were selected from the Medical Information Marketplace in Critical Care IV (MIMIC-IV) database. Inclusion criteria: ICD diagnosis codes=k56,k560,k567,5601. exclusion criteria: 1.days of survival on admission≤1 day; 2. various malignant tumors; 3. age≤18; 4. not the first ICU admission; 5. length of ICU stay≤1 day; 6. missing lactate data. Different models were constructed to explore the relationship between lactate and 28 d mortality. Results: A total of 1472 patients with paralytic bowel obstruction were included. 28-day mortality was 16.85% (n = 248). After screening the variables using Lasso regression, all the variables obtained were included in a logistic regression model, and a one-way logistic regression showed that the ratio of the odds ratios (OR) for 28-day mortality per 1 mmol/l increase in lactate was 1.21 (95% CI 1.14-1.28, p < 0.001). Significant variables obtained from univariate logistic regression were incorporated into multivariate logistic regression, and the final model showed that lactate was an independent risk factor for predicting 28-day mortality, with an odds ratio (OR) of 1.14 (95% CI 1.07-1.21, P < 0.001) for each 1 mmol/l increase in lactate. The area under the ROC curve (AUC) was 0.65 for lactate and 0.792 for the final model.The RCS model and the smoothed fitted curves showed a nonlinear positive correlation between lactate and 28-day mortality.The K-M curves showed that the group with higher values of LAC had a lower survival rate. Conclusion: Elevated LAC is associated with increased 28-day mortality in ICU paralytic bowel obstruction. This study helps to further explore the relationship between LAC and mortality in patients with paralytic bowel obstruction.