Lactate and lactate clearance in acute cardiac care patients

Attanà, Paola; Lazzeri, Chiara; Picariello, Claudio; Dini, Carlotta Sorini; Gensini, Gian Franco; Valente, Serafina

doi:10.1177/2048872612451168

Cited by 63 publications

(51 citation statements)

References 53 publications

(54 reference statements)

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“…This metabolic rearrangement, known as the Pasteur effect, represents the major adaptive mechanism to survive hypoxia. 27,28 The significant correlation we found between WIT and lactate values measured before nRP start may confirm previous data on cardiac arrest 29,30 and the strict link between hypoperfusion and hyperlactatemia. On the other hand, the lack of changes in lactate values during nRP is more difficult to interpret.…”

Section: Discussionsupporting

confidence: 87%

A metabolic approach during normothermic regional perfusion in uncontrolled donors after circulatory death—A pilot study

Peris

Lazzeri

Bonizzoli

et al. 2018

Clinical Transplantation

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The use of donation after circulatory death (DCD) has increased significantly to face the persistent mismatch between supply and demand of organs for transplantation. While controlled (c) DCDs have warm ischemic time (WIT) that can be estimated, the WIT is often inexact and extended in uncontrolled DCD (uDCD), making assessment of injury difficult. We aimed at investigating the effects of cold ischemia on potential donor organ damage in the course of nRP by assessing the dynamic variations of transaminases and creatinine values in 17 uDCD donors. In our series, lactate values did not show significant changes during the study period (P = 0.147). Creatinine values did not significantly changed while transaminases progressive increased throughout the study period, even if it was significant only for AST (P = 0.035). According to our data, nRP duration affects splanchnic organs, being the liver sensitive to hypoperfusion, and serial biochemical measurements could help in detecting organ functional status.

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Section: Discussionsupporting

confidence: 87%

A metabolic approach during normothermic regional perfusion in uncontrolled donors after circulatory death—A pilot study

Peris

Lazzeri

Bonizzoli

et al. 2018

Clinical Transplantation

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“…While the prognostic role of hyperlactatemia in several critical ill diseases (such as sepsis and trauma) is well established, data in patients with acute cardiac conditions (i.e., acute coronary syndromes) are scarce and controversial. Blood lactate concentration obtained on emergency department on arrival may identify patients with critical cardiac illness (e.g., acute myocardial infarction), severe congestive heart failure, serious arrhythmias, and cardiogenic shock and correlates with a poor short-term outcome after AMI and cardiac surgery [13]. Lazzeri et al [14], in the regression analysis, also proved that lactate levels were an independent predictor for intraintensive cardiac care unit mortality in patients with insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

Hyperlactatemia and the Outcome of Type 2 Diabetic Patients Suffering Acute Myocardial Infarction

Aleksandar¹,

Perić²,

Marković-Jovanović³

et al. 2016

Journal of Diabetes Research

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Background. Increased lactate production is frequent in unregulated/complicated diabetes mellitus. Methods. Three groups, each consisting of 40 patients (type 2 diabetics with myocardial infarction, DM+AMI, nondiabetics suffering myocardial infarction, MI, and diabetics with no apparent cardiovascular pathology, DM group), were tested for pH, serum bicarbonate and electrolytes, blood lactate, and CK-MB. Results. Blood lactate levels were markedly higher in AMI+DM compared to MI group (4.54 ± 1.44 versus 3.19 ± 1.005 mmol/L, p < 0.05); they correlated with the incidence of heart failure (ρ = 0.66), cardiac rhythm disorders (ρ = 0.54), oxygen saturation (ρ = 0.72), CK-MB levels (ρ = 0.62), and poor short-term outcome. Lactic acidosis in DM+AMI group was not always related to lethal outcome. Discussion. The lactate cutoff value associated with grave prognosis depends on the specific disease. While some authors proposed cutoff values ranging from 0.76 to 4 mmol/L, others argued that only occurrence of lactic acidosis may be truly predictive of lethal outcome. Conclusion. Both defective glucose metabolism and low tissue oxygenation may contribute to the lactate production in diabetic patients with acute myocardial infarction; high lactate levels indicate increased risk for poor outcome in this population comparing to nondiabetic patients. The rise in blood lactate concentration in diabetics with AMI was associated with increased incidence of heart failure, severe arrhythmias, cardiogenic shock, and high mortality rate.

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“…The three most widely used prediction models in the Intensive Care Unit (ICU); the Acute Physiology and Chronic Health Evaluation (APACHE), Mortality Probability Model (MPM) and the Simplified Acute Physiology Score (SAPS) were initially developed more than 30 years ago and have been updated several times since, in order to improve the mortality prediction after ICU admission . Although there is ample evidence for lactate concentration being a strong predictor of mortality and the fact that it is routinely measured in many ICUs, none of these three models include lactate levels in their algorithms.…”

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confidence: 99%