Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis

Vellinga, Namkje A. R.; Boerma, E. Christiaan; Koopmans, Matty; Donati, Abele; Dubin, Arnaldo; Shapiro, Nathan I.; Pearse, Rupert M.; Voort, Peter H. J. van der; Dondorp, Arjen M.; Bafi, Tony; Fries, Michael; Akarsu-Ayazoglu, Tulin; Pranskūnas, Andrius; Hollenberg, Steven M.; Balestra, G; Iterson, Mat van; Sadaka, Farid; Minto, Gary; Aypar, Ülkü; Hurtado, Francisco Javier; Martinelli, Giampaolo; Payen, Didier; Haren, Frank van; Holley, Anthony; Gómez, Hernando; Mehta, Ravindra L.; Rodríguez, Alejandro; Ruíz, Carolina; Canales, Héctor Saúl; Duranteau, Jacques; Spronk, Peter E.; Jhanji, Shaman; Hubble, Sheena; Chierego, Marialuisa; Jung, Christian; Martin, Daniel S.; Sorbara, Carlo; Bakker, Jan; İnce, Can

doi:10.1186/s13054-017-1842-7

Cited by 29 publications

(22 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two others important predictors of mortality were identified in our study, namely lactate level and mean urine output at H6. Lactate level has been previously associated with outcome in septic patients [31, 32] together with its clearance during resuscitation [33–36]. However, an interesting finding in our study was the relationship between the prognostic effect of the mottling score and arterial lactate.…”

Section: Discussionmentioning

confidence: 52%

Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parameters

et al. 2019

View full text Add to dashboard Cite

Background Mottling score, a tissue perfusion parameter, is correlated with outcome in septic shock patients. However, its predictive value on mortality according to prognostic covariates such as vasopressor dose and other tissue perfusion parameters remains unknown. Methods Mottling score and tissue perfusion parameters were recorded at ICU admission (H0), H-6, H 12, and H-24 and used to assess the predictive value of mottling score on 14-day mortality in a development cohort. Results were then validated in an independent cohort of septic shock patients in Brazil. Results Overall, 259 patients with sepsis or septic shock were included, 14-day mortality was 37%. Factors associated with death were mottling score (OR 2.26 [95% CI, 1.72–2.97]), arterial lactate level (OR 1.29 [1.11–1.5]), and urine output < 0.5 ml/Kg/h (OR 3.03 [1.37–6.69]). The C statistic for the model was 0.90 in the development cohort and 0.76 in the validation cohort. The predictive value of mottling score was not affected by vasopressor doses ( p for interaction = 0.33): OR for mottling score ranged from 2.34 [1.10–3.15] in patients without vasopressor to 3.84 [1.98–7.43] in patients infused with high doses of vasopressor (> 0.8 μg/kg/min). There was no difference in the effect of mottling score on mortality according to mean arterial pressure, heart rate, cardiac index, and urine output, but we found a significant interaction between arterial lactate level and mottling score ( p = 0.04). The predictive value of the mottling score remains significant when using the recent SEPSIS-3 definition of septic shock. Finally, a decrease of mottling score during resuscitation was significantly associated with better outcome after adjustment on SOFA score ( p = 0.001). Conclusions Our results support the high prognostic value of mottling score for 14-day mortality in septic patients, whatever vasopressor dosage and other perfusion parameters. Mottling score variations during resuscitation are also predictive of mortality. Electronic supplementary material The online version of this article (10.1186/s13054-019-2496-4) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 52%

Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parameters

et al. 2019

View full text Add to dashboard Cite

show abstract

“…For general critically ill patients, lactate has been widely used as a marker of disease severity and associated with higher overall mortality . Biologically, lactate has been accepted as a surrogate of physiological stress, microcirculatory dysfunction or tissue hypoxia from multiple aetiologies . In liver failure, lactate clearance may be further impaired by mechanisms yet to be fully understood .…”

Section: Discussionmentioning

confidence: 99%

Lactate and number of organ failures predict intensive care unit mortality in patients with acute‐on‐chronic liver failure

Cardoso

Abraldes

et al. 2019

Liver International

View full text Add to dashboard Cite

Background and Aims:Patients with acute-on-chronic liver failure (ACLF) have high mortality rates. Most prognostic scores were not developed for the intensive care unit (ICU) setting. We aimed to improve risk stratification for patients with ACLF in the ICU. Methods:A training set with 240 patients with cirrhosis and organ failures (Chronic was used to derive a prognostic model for ICU mortality. A validation set with 237 patients with cirrhosis and organ failures from Vancouver General Hospital (Canada) in 2000-2011 was used to evaluate its performance. Results: Amongst patients in the training set, ICU and hospital mortality rates were 39.2% and 54.6% respectively. Median lactate (4.4 vs 2.5 mmol/L) and number of organ failures (3 vs 2) on admission to ICU were associated with higher likelihood of ICU mortality (P < 0.001 for both). The lactate and organ failures predictive model (LacOF) was derived to predict ICU mortality: −2.420 + 0.072 × lactate + 0.569 × number of organ failures (area under-the-curve [AUC], 0.76). In the validation set, the LacOF model discriminative ability (AUC, 0.85) outperformed the CLIF-SOFA (AUC, 0.79), Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (AUC, 0.73), Model for End-stage Liver Disease score (AUC, 0.78) and Acute Physiology and Chronic Health Evaluation II scores (AUC, 0.74; P < 0.05 for all). The LacOF model calibration was good up to the 25% likelihood of ICU mortality. Conclusions:In patients with ACLF, lactate and number of organ failures on admission to ICU are useful to predict ICU mortality. This early prognostic evaluation may help to better stratify the risk of ICU mortality and thus optimize organ support strategies. K E Y W O R D Scirrhosis, critical care, death, prognosis

show abstract

“…Hernandez et al [ 29 ] found that the presence of hyperlactatemia and high norepinephrine requirements increases the odds of identifying a severe underlying microvascular dysfunction during sublingual microcirculatory assessments in patients with septic shock. Conversely, Vellinga et al [ 30 ] identified that microcirculatory flow abnormalities do not differ between patients with and without mildly elevated lactate levels. Patients with a capillary MFI <2.6 tend to have higher lactate levels than those in patients with a higher MFI.…”

Section: Discussionmentioning

confidence: 99%

Time of dissociation between microcirculation, macrocirculation, and lactate levels in a rabbit model of early endotoxemic shock

Zhang¹,

Wu³

et al. 2020

Chinese Medical Journal

View full text Add to dashboard Cite

Background The relationship between macrocirculation and microcirculation remains controversial. The loss of coherence between microcirculation and macrocirculation has already been found in late-stage sepsis shock. The objective of this study was to determine the earliest possible time of detecting the loss of coherence between microcirculation and macrocirculation in early-stage endotoxemic shock. Methods We randomized 24 female New Zealand white rabbits into two groups: endotoxemic shock group ( n = 14) and control group ( n = 10). Rabbits in the endotoxemic shock group were equipped with arterial and venous catheters and received an intravenous infusion of Escherichia coli lipopolysaccharide (LPS, 2 mg/kg over 10 min). Rabbits in the control group received the same dose of saline infusion. Microcirculatory perfusion parameters were assessed in the sublingual mucosa using sidestream dark-field video microscopy. Systemic hemodynamics and blood lactate levels were measured at baseline and over a 120-min period. Results Ninety minutes after completing LPS infusion, all animals in the endotoxemic shock group developed a hypodynamic septic condition, characterized by low cardiac output and increased systemic vascular resistance; 120 min after completing LPS infusion, the mean arterial pressure decreased by 25% ( P = 0.01), confirming ongoing endotoxemic shock. However, significant decreases in sublingual microcirculatory parameters of small vessels (microvascular flow index, perfused vessel density, and proportion of small perfused vessels) were observed 30 min after completing LPS infusion ( P = 0.01, for all), and threshold decreases of 30% were found 60 min after completing LPS infusion ( P = 0.001, for all) in the endotoxemic shock group. Lactate levels significantly increased to more than 2 mm/L at 90 min and more than 4 mm/L at 120 min in the endotoxemic shock group ( P = 0.02 and P = 0.01, respectively). Conclusions Changes in microcirculatory perfusion precede changes in macrocirculation and lactate levels in a rabbit model of endotoxemia shock. Microcirculation, macrocirculation, and oxygen metabolism are distinct in early-stage endotoxic shock.

show abstract

Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis

Cited by 29 publications

References 40 publications

Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parameters

Mottling score is a strong predictor of 14-day mortality in septic patients whatever vasopressor doses and other tissue perfusion parameters

Lactate and number of organ failures predict intensive care unit mortality in patients with acute‐on‐chronic liver failure

Time of dissociation between microcirculation, macrocirculation, and lactate levels in a rabbit model of early endotoxemic shock

Contact Info

Product

Resources

About