949

Abstract

Learning Objectives: Lactate is a biomarker that is followed to assess inadequate perfusion in patients with severe sepsis and septic shock. In many clinical laboratories a normal lactate level is < 2.0 -2.2 mmol/L depending on the assay. The liver is the main organ of lactate clearance. Patients with end-state liver disease (ESLD) are presumed to have significant impairment in lactate clearance. However, we find no evidence in the literature demonstrating that these patients have baseline elevated lactate levels. We sought to determine the relationship between measured whole blood lactate and Model for End-Stage Liver Disease (MELD) score in patients with ESLD undergoing orthotopic liver or combined liver and kidney transplants. Methods: A retrospective chart review and analysis was performed with the first intraoperative measured whole blood lactate level and calculated MELD score of 344 patients undergoing either orthotopic liver transplant or combined orthotopic liver and kidney transplant at . These patients had documented ESLD and were without active infection, severe sepsis or septic shock. The UCSF Committee for Human Research study approved the study. The relationship between MELD scores and elevated lactate (>2.0 mmol/L) was analyzed by logistic regression and receiver operating characteristic (ROC) curves. Results: MELD score was significantly related to elevated lactate (P<0.0001) with an area under the ROC curve of 0.76 (95% CI 0.70 to 0.82), when utilizing a lactate level >2.0 mmol/L as a threshold for abnormal lactate. For MELD scores < 10, 10-19, 20-29, 30-34, and ≥ 35, the percentage of patients that had an elevated lactate were 13.5%, 9.6%, 15.9%, 30.4%, and 54.8% respectively. Conclusions: Higher baseline lactate levels are an important consideration for patients with ESLD who develop severe sepsis or septic shock. In ESLD patients, a mildly elevated lactate may represent end-organ dysfunction rather than inadequate perfusion, and therefore a false positive for diagnostic criteria for sepsis.