Hyperlactatemia and the Importance of Repeated Lactate Measurements in Critically Ill Patients

Godinjak, Amina; Jusufović, Selma; Rama, Admir; Iglica, Amer; Zvizdić, Faris; Kukuljac, Adis; Tančica, Ira; Rozajac, Sejla

doi:10.5455/medarh.2017.71.404-407

Cited by 16 publications

(13 citation statements)

References 35 publications

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“…In critically ill patients suspected with sepsis, the blood lactate level at the time of admission is typically >2 mmol/L and <4 mmol/L. Following a 48-hour ITU admission, a lactate level of 2.25 mmol/L has been identified to be fatal (predictor of mortality with a sensitivity of 72.2 % and specificity of 92.1%) [ 47 ]. Therefore, future work will focus on (1) repeated in vitro studies with whole blood and serum as analytes (lactate range: 0–10 mmol/L) to generate a large set of NIR spectra, and (2) improving the multivariate models for better accuracy.…”

Section: Discussionmentioning

confidence: 99%

Identification and Quantitative Determination of Lactate Using Optical Spectroscopy—Towards a Noninvasive Tool for Early Recognition of Sepsis

Budidha

Mamouei

Baishya

et al. 2020

Sensors

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Uninterrupted monitoring of serum lactate levels is a prerequisite in the critical care of patients prone to sepsis, cardiogenic shock, cardiac arrest, or severe lung disease. Yet there exists no device to continuously measure blood lactate in clinical practice. Optical spectroscopy together with multivariate analysis is proposed as a viable noninvasive tool for estimation of lactate in blood. As an initial step towards this goal, we inspected the plausibility of predicting the concentration of sodium lactate (NaLac) from the UV/visible, near-infrared (NIR), and mid-infrared (MIR) spectra of 37 isotonic phosphate-buffered saline (PBS) samples containing NaLac ranging from 0 to 20 mmol/L. UV/visible (300–800 nm) and NIR (800–2600 nm) spectra of PBS samples were collected using the PerkinElmer Lambda 1050 dual-beam spectrophotometer, while MIR (4000–500 cm−1) spectra were collected using the Spectrum two FTIR spectrometer. Absorption bands in the spectra of all three regions were identified and functional groups were assigned. The concentration of lactate in samples was predicted using the Partial Least-Squares (PLS) regression analysis and leave-one-out cross-validation. The regression analysis showed a correlation coefficient (R2) of 0.926, 0.977, and 0.992 for UV/visible, NIR, and MIR spectra, respectively, between the predicted and reference samples. The RMSECV of UV/visible, NIR, and MIR spectra was 1.59, 0.89, and 0.49 mmol/L, respectively. The results indicate that optical spectroscopy together with multivariate models can achieve a superior technique in assessing lactate concentrations.

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Section: Discussionmentioning

confidence: 99%

Identification and Quantitative Determination of Lactate Using Optical Spectroscopy—Towards a Noninvasive Tool for Early Recognition of Sepsis

Budidha

Mamouei

Baishya

et al. 2020

Sensors

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“…The most common cause is tissue hypoxia, in which lactate is the end product of glycolysis under anaerobic conditions. But this can also occur in disorders unrelated to tissue hypoxia (type B lactic acidosis) [7,8,9]. There is a direct relationship between lactate levels and poor outcomes [4].…”

Section: Discussionmentioning

confidence: 99%

“…The optimal lactate cut-off value and the timing of lactate measurement to stratify the sickest patients are still unclear. Larger reductions from baseline lactate levels are associated with better outcomes [3,7,9,11].…”

Section: Discussionmentioning

confidence: 99%

Glucose and Lactate Levels at Admission as Predictors of In-hospital Mortality

Sotello

Yang

Nugent

2019

Cureus

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ObjectiveGlucose and lactate levels in patients at the time of admission have been studied in diverse patient groups. Some studies suggest that elevated glucose levels at admission predict worse outcomes. Elevated Lactate levels have also been reported to be directly associated with increased mortality. We wanted to determine if the combination of admission glucose and lactate levels improves the predictability of inpatient mortality and length of stay (LOS).MethodsThis is a retrospective study. We included all adult patients admitted at an academic medical center from October 1, 2015 to September 30, 2016. We collected basic clinical information, including age, gender, admission glucose and lactate levels, LOS, and mortality. We separated outcomes based on glucose and lactate levels by dividing them into quartiles. We also stratified patients based on normal lactate (<2.0 mmol/L), high lactate (2.0-4.0 mmol/L), and very high lactate (>4 mmol/L) levels; and on normal glucose (60-140 mg/dl), high glucose (140-200 mg/dl), and very high glucose (>200 mg/dl) levels.ResultsA total of 5,436 adult patients were included in our study. The median age was 58 years, and 57% of the patients were male. The median LOS was 6 days, and the overall in-hospital mortality rate was 11%. When the patients were separated in quartiles based on admission glucose values, mortality was higher in the 4th quartile (≥173 mg/dL): 14.87%, probability value (p): <0.001. When the patients were separated in quartiles based on lactate levels, the mortality was higher in the 4th quartile (≥2.23 mmol/L): 21.95%, p: 0.001. When the patients were paired according to normal, high, or very high lactate and glucose levels, the groups that had higher mortality were as follows: normal glucose/very high lactate: 32.43%; high glucose/very high lactate: 34.04%; and very high glucose and very high lactate: 39.15%. The groups with very high glucose and very high lactate had increased odds of mortality when compared with the other groups (p: <0.001).ConclusionsAdmission glucose and lactate levels provide useful information in the estimation of inpatient mortality. The LOS was shortened in the groups with higher glucose, lactate, or both. The combination of glucose and lactate levels predicted mortality better than either value alone.

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“…All lactate values above 2 mmol/L were considered as elevated. 9 Patients, those who had an initial (before incision) intra-arterial blood lactate level higher than 2 mmol/L, were excluded from the study. The patients were divided into two groups as those with persistently elevated lactate levels in the perioperative duration and those without persistent perioperative blood lactate concentrations.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for persistent elevation of perioperative lactate levels in gastric cancer surgery

et al. 2020

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Background: The impact of high-risk surgery on tissue perfusion can be indirectly assessed by measuring lactate levels during surgery and intensive care unit (ICU) stay. While consistently high values are associated with poor prognosis, transient elevations do not mean poor clinical outcomes. Therefore, intraoperative and early postoperative blood lactate monitoring is essential for cancer patients. Aims and Objective: This study aimed to determine the risk factors of persistently elevated lactate levels in the intraoperative and postoperative period in patients with elective gastric cancer surgery. Materials and Methods: We retrospectively enrolled 293 patients who underwent curative resection for gastric cancer. Lactate values of all patients were examined during surgery and ICU-stay at 3rd, 6th, 12th, and 18th hours. All lactate values above 2 mmol/L were considered elevated. The patients were divided into two groups as those with perioperative persistently increased lactate levels and those without. Results: Of the 293 patients, 60 (20.5%) had higher lactate levels in the perioperative period. According to multivariate logistic regression analysis, the operative time had the highest significance rate (p = 0.020) out of two significant variables, followed by the BMI ≥ 30 kg/m2 (p = 0.048). Besides, patients with perioperative hyperlactatemia had prolonged hospital stays (p = 0.034). Conclusions: Operative time and obesity (BMI ≥ 30 kg/m2) were independent risk factors for persistent lactate elevation in the perioperative period. Also, perioperative hyperlactatemia extended the length of hospital stay.

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Hyperlactatemia and the Importance of Repeated Lactate Measurements in Critically Ill Patients

Cited by 16 publications

References 35 publications

Identification and Quantitative Determination of Lactate Using Optical Spectroscopy—Towards a Noninvasive Tool for Early Recognition of Sepsis

Identification and Quantitative Determination of Lactate Using Optical Spectroscopy—Towards a Noninvasive Tool for Early Recognition of Sepsis

Glucose and Lactate Levels at Admission as Predictors of In-hospital Mortality

Risk factors for persistent elevation of perioperative lactate levels in gastric cancer surgery

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