Hyperlactatemia is a predictor of mortality in patients undergoing continuous renal replacement therapy for acute kidney injury

Abstract

Background Hyperlactatemia occurs frequently in critically ill patients, and this pathologic condition leads to worse outcomes in several disease subsets. Herein, we addressed whether hyperlactatemia is associated with the risk of mortality in patients undergoing continuous renal replacement therapy (CRRT) due to acute kidney injury. Methods A total of 1,661 patients who underwent CRRT for severe acute kidney injury were retrospectively reviewed between 2010 and 2020. The patients were categorized according to their serum lactate levels, such as high (≥ 7.6 mmol/l), moderate (2.1–7.5 mmol/l) and low (≤ 2 mmol/l), at the time of CRRT initiation. The hazard ratios (HRs) for the risk of in-hospital mortality were calculated with adjustment of multiple variables. The increase in the area under the receiver operating characteristic curve (AUROC) for the mortality risk was evaluated after adding serum lactate levels to the Sequential Organ Failure Assessment (SOFA) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score-based models. Results A total of 802 (48.3%) and 542 (32.6%) patients had moderate and high lactate levels, respectively. The moderate and high lactate groups had a higher risk of mortality than the low lactate group, with HRs of 1.64 (1.22–2.20) and 4.18 (2.99–5.85), respectively. The lactate-enhanced models had higher AUROCs than the models without lactates (0.764 vs. 0.702 for SOFA score; 0.737 vs. 0.678 for APACHE II score). Conclusions Hyperlactatemia is associated with mortality outcomes in patients undergoing CRRT for acute kidney injury. Serum lactate levels may need to be monitored in this patient subset.

Clostridioides difficile Infection in Hospitalized Patients—A Retrospective Epidemiological Study

“…Moreover, recurrent CDI episodes were consistently more prevalent in females and severe episodes were more frequent in males. These findings are in agreement with other studies, indicating that women are more susceptible to recurrence, due to variations in microbiota composition influenced by hormonal factors and differences in immune response mechanisms, that may increase the risk of CD colonization and overgrowth [52,53].…”

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

“…Second, the lack of information on the Glasgow Coma Scale and lactate levels prevented us from assessing their association with the prognosis of the participants in this study. The lack of lactate levels may create a gap in our understanding of the pathophysiology and severity of AKI, especially since lactate levels are an indicator of tissue perfusion failure and metabolic disturbances in patients with AKI [ 32 ]. Third, it does not apply to the prediction of short-term mortality because it excludes death within 48 h. Fourth, we excluded patients with an eGFR ≥ 60 to focus on worsening chronic renal failure.…”

Clinical characteristics and prognosis of patients with COVID-19 on mechanical ventilation undergoing continuous renal replacement therapy

“…Previously, the mortality in patients with COVID-19 who underwent RRT was found to be similar [ 18 ] or even higher than those without RRT [ 14 , 30 – 32 ]. In addition, it has been known that high level of lactate is a predictor of mortality in patients undergoing CRRT for acute kidney injury [ 33 ].…”