{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T18:13:22Z","timestamp":1788459202782,"version":"build-2803163510"},"reference-count":47,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82370605"],"award-info":[{"award-number":["82370605"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"award":["82370605"],"award-info":[{"award-number":["82370605"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Institute of Health Big Data and Population Medicine","award":["JKS2023002"],"award-info":[{"award-number":["JKS2023002"]}]},{"name":"Lu\u2019an City Science and Technology Bureau Research Project","award":["2024lakj013"],"award-info":[{"award-number":["2024lakj013"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Sepsis-associated liver injury (SALI) is a severe complication of sepsis that significantly increases the risk of mortality in intensive care unit (ICU) patients. While lactate is recognized as a prognostic biomarker for sepsis, the predictive potential of dynamic lactate trajectories in patients with SALI has not been investigated. This study aims to elucidate the association between serum lactate trajectories and clinical outcomes. Methods: Latent class trajectories of serum lactate dynamics were modeled in 524 patients with SALI from the MIMIC-IV dataset. Serum lactate levels were measured once daily for four consecutive days after ICU admission. Seven distinct trajectory phenotypes were identified, and their prognostic value was assessed using multivariate Cox regression. Results: The seven lactate trajectory phenotypes identified in SALI patients included the Class 1 low-stable, Class 2 moderate-slow decline, Class 3 low-slow decline, Class 4 moderate-slow decline and mild increase, Class 5 moderate-slow decline and rapid increase, Class 6 high-rapid decline, and Class 7 moderate-persistence groups. Fully adjusted multivariate Cox regression indicated significantly elevated mortality risk in Class 5 (HR 2.81, 95% CI 1.67\u20134.74) and Class 7 (HR 3.44, 95% CI 2.02\u20135.85) (all p &lt; 0.001), whereas Classes 1\u20134 and 6 showed no significant differences. The XGBoost classifier achieved a test set AUROC of 0.7098 (training AUROC = 0.9029), indicating limited generalizability due to overfitting. SHAP analysis was used for exploratory purposes to identify potential predictors, with pH, platelets, and alkaline phosphatase emerging as dominant features. Conclusions: Substantial heterogeneity in lactate trajectories was found among patients with SALI, establishing these dynamic patterns as robust predictors of clinical outcomes.<\/jats:p>","DOI":"10.3390\/jcm15176837","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:13:25Z","timestamp":1788455605000},"page":"6837","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Lactate Trajectories and Clinical Outcomes in Critically Ill Patients with Sepsis-Associated Liver Injury"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3704-2265","authenticated-orcid":false,"given":"Hong","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230001, China"},{"name":"Department of Emergency Medicine, Affiliated Lu\u2019an Hospital of Anhui Medical University, Lu\u2019an 237005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5847-4427","authenticated-orcid":false,"given":"Sijie","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anhui Provincial Cancer Institute, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunlong","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Affiliated Lu\u2019an Hospital of Anhui Medical University, Lu\u2019an 237005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1007\/s00134-020-06151-x","article-title":"Incidence and mortality of hospital- and ICU-treated sepsis: Results from an updated and expanded systematic review and meta-analysis","volume":"46","author":"Mellhammar","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1001\/jama.2017.13836","article-title":"Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009\u20132014","volume":"318","author":"Rhee","year":"2017","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0140-6736(18)30696-2","article-title":"Sepsis and septic shock","volume":"392","author":"Cecconi","year":"2018","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1146\/annurev-immunol-051116-052415","article-title":"Immune Responses in the Liver","volume":"36","author":"Kubes","year":"2018","journal-title":"Annu. 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