Initial lactate levels were associated with 14-day mortality in univariate analysis but were not an independent predictor after multivariable adjustment, while sodium and potassium levels were independently associated with short-term mortality in patients with ischemic stroke.
Key Findings
Results
Lactate levels were significantly associated with 14-day mortality in univariate analysis but were not independent risk factors after multivariable adjustment.
Univariate analysis showed lactate levels were significantly associated with 14-day mortality (P < .05)
Multivariable logistic regression revealed lactate levels were not independent risk factors (P > .05)
The study included 157 patients with ischemic stroke: 107 in the survival group and 50 in the death group
Patients with high-risk underlying diseases such as hypertension and diabetes were excluded
Results
Potassium and sodium ion levels were identified as independent risk factors for 14-day mortality in ischemic stroke patients.
Both potassium and sodium ion levels were independently associated with short-term mortality (P < .05) in multivariable logistic regression
This finding held after adjustment for other variables including lactate
The study population was drawn from the MIMIC-IV database
Cases with high-risk comorbidities such as hypertension and diabetes were excluded to reduce confounding
Results
The discriminative performance of lactate alone for predicting 14-day mortality was limited.
The area under the ROC curve (AUC) for lactate was 0.637 (95% CI: 0.546–0.728)
AUC values for potassium and sodium ions were also between 0.60 and 0.70, indicating limited predictive ability for all three markers
ROC curve analysis was used to evaluate the predictive ability of lactate and other biochemical indicators
Results
Subgroup analysis revealed different associations between lactate and electrolytes depending on survival status.
In the survival group, lactate was associated with sodium, chloride, and blood glucose levels
In the non-survival group, lactate was associated with calcium, sodium, and chloride ions
These findings suggest potential differences in lactate-electrolyte interactions between patients with different mortality risks
Subgroup analysis was performed to explore the interaction of biochemical indicators across patient groups
Methods
The study was a retrospective cohort study based on the MIMIC-IV database that excluded patients with hypertension and diabetes.
A total of 157 patients with ischemic stroke were included
Cases with high-risk underlying diseases such as hypertension and diabetes were excluded
Univariate and multivariate logistic regression analyses were used to evaluate the relationship between lactate levels and short-term mortality risk
The outcome of interest was mortality within 14 days of admission
What This Means
This research examined whether blood lactate levels measured on hospital admission could predict the risk of dying within 14 days among patients admitted to intensive care with ischemic stroke. Using data from 157 ischemic stroke patients in a large medical database (MIMIC-IV), the researchers found that while high lactate levels appeared linked to 14-day mortality in a simple analysis, this association disappeared once other factors were accounted for. This means lactate on its own does not independently predict short-term death risk in this population.
Instead, the levels of two common electrolytes — sodium and potassium — emerged as the stronger, independent predictors of 14-day mortality. The study also found that lactate was only moderately useful as a predictive test on its own, with an accuracy score (AUC) of 0.637, where 1.0 would be perfect and 0.5 would be no better than chance. Sodium and potassium performed similarly, all falling in a 'limited' predictive range between 0.60 and 0.70.
This research suggests that in ischemic stroke patients without major comorbidities like hypertension or diabetes, clinicians may need to look beyond lactate and pay close attention to electrolyte imbalances — particularly sodium and potassium — when assessing short-term mortality risk. The study's relatively small sample size (157 patients) and its exclusion of patients with common conditions like hypertension and diabetes limit how broadly these findings can be applied, and larger studies would be needed to confirm these results.
Zhu Y, Liu X, Song H. (2026). Initial lactate levels and 14-day mortality in ischemic stroke: A retrospective cohort study using the MIMIC-IV database.. Medicine. https://doi.org/10.1097/MD.0000000000050308