Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill

Khosravani, Houman; Shahpori, Reza; Stelfox, Henry T.; Kirkpatrick, Andrew W.; Laupland, Kevin B.

doi:10.1186/cc7918

Cited by 166 publications

(130 citation statements)

References 26 publications

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“…Similarly, lactatemia on admission to the ICU is a well-known prognostic and severity marker. 33,34 In the early postoperative period after LT, these factors could also be considered surrogate markers of inflammation or prothrombotic disorders induced by the surgery and liver graft function. The duration of postoperative mechanical ventilation after LT could also be related to these factors.…”

Section: Discussionmentioning

confidence: 99%

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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Early-onset hospital-acquired pneumonia (E-HAP) is one of the leading causes of sepsis and mortality after liver transplantation (LT). The appropriate antimicrobial therapy is crucially important for surviving sepsis in this context. The aim of this study was to analyze microbiological findings, associated factors, and optimal antibiotic regimens for E-HAP after LT. Patients demonstrating E-HAP in a single-center cohort of 148 LT recipients were prospectively detected. The diagnosis of pneumonia relied on a combination of supportive clinical findings and a positive culture of a lower respiratory tract sample. E-HAP was considered present if pneumonia occurred within 6 days of intensive care unit (ICU) admission after LT. Twenty-three patients (15.5%) developed E-HAP, which were caused by 36 pathogens (61.1% were gram-negative bacilli, and 33.3% were classified as hospital-acquired). For patients who developed E-HAP, the duration of mechanical ventilation and the ICU stay were significantly longer. Despite a trend toward higher mortality at any time in the E-HAP group, there was no significant difference in mortality between patients with E-HAP and patients without E-HAP. Lactatemia, vasopressor requirements, Simplified Acute Physiology Score II (SAPS II) score on ICU admission, and mechanical ventilation lasting more than 48 hours after LT were associated with E-HAP. Combinations of broad-spectrum b-lactams and aminoglycosides were active against more than 91% of the encountered pathogens. However, antibiotic de-escalation was possible in more than one-third of cases after identification of the pathogens. In conclusion, E-HAP after LT is a severe condition that appears to be influenced by physiological derangements induced by the surgery, such as lactatemia, vasopressor requirements, and mechanical ventilation requirements, as well as the postoperative SAPS II score. At the time of treatment initiation, an antimicrobial regimen usually proposed for late-onset pneumonia should be followed. Orthotopic liver transplantation (LT) is a widely accepted treatment for patients with end-stage liver disease. Despite global improvements in survival over the last few decades, sepsis remains the leading cause of early postoperative mortality. 1,2 Lower respiratory tract infections are a major concern in this context.

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Section: Discussionmentioning

confidence: 99%

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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“…As a matter of fact, hyperlactatemia was firstly reported as a parameter for measurement of "reversibility" [16]. Then, in recent years, most reports show a prognostic value of hyperlactatemia on predicting mortality in both adults and children in lots of medical illnesses, including shock, sepsis, trauma, surgery and especially after cardiac interventions [17][18][19][20][21][22]. Although there are reports that admission hyperlactatemia predicts mortality and clinical outcome, the predictive value of a single lactate assessed on admission is controversial.…”

Section: Discussionmentioning

confidence: 99%

The reasons of hyperlactatemia on admission and relationship of the lactate levels with clinical outcomes in pediatric intensive care unit

Bağ¹,

Karaarslan²,

İşgüder³

et al. 2017

Pau Med J

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Purpose:Hyperlactatemia has been reported to predict mortality and morbidity in critically ill patients. The aim of this study is to define the reasons of hyperlactatemia on admission in critical pediatric patients, to describe a cut off value to predict mortality and to evaluate the outcomes of admission hyperlactatemia in pediatric intensive care unit. Materials and methods: Hospital records of 202 pediatric patients who had admitted to pediatric intensive care unit (Male/Female: 101/101; median age: 3 years [IQR: 9.2] ) were evaluated retrospectively, for the study. Age, gender, admission diagnosis, arterial blood gas analysis, length of stay, presence of in-hospital mortality were recorded in the study group. Hyperlactatemia was defined according to L-lactate levels defined by age. The patients with and without hyperlactatemia were compared for mortality and clinical outcomes. Results:The frequency of admission hyperlactatemia was 64.3% (n: 130). The patients with dehydration due to acute gastroenteritis, acute respiratory insufficiency and acaute cardiac insufficiency had significantly higher lactate levels compared with children with other diagnosis. Admission hyperlactatemia was not found to have a cut-off value to predict mortality by ROC analysis (Area under curve: 0.57). Moreover, hyperlactatemia was not found to effect either mortality rate or outcome in the study group. Conclusion:The results of this study indicate that admission hyperlactatemia may not be used as a predictor of either death or poor clinical outcome in pediatric intensive care units. Further there is a lack of cut off value for lactate in literature to predict outcomes in different pediatric ages. Pam Med J 2017;(1):1-6Key words: Hyperlactatemia, admission, childhood, PICU. ÖzetAmaç: Laktat yüksekliğinin kritik hasta izleminde mortalite ve morbiditeyi belirleyici olduğunu gösteren çalişmalar mevcuttur. Bu araştirmanin amaci, kritik hastaliği olan çocuklarda laktat yüksekliğinin nedenlerini belirlemek, mortaliteyi belirleyen bir eşik değer olup olmadiğini saptamak ve çocuk yoğun bakim ünitesinde laktat yüksekliğinin klinik sonuçlarini değerlendirmektir. Gereç ve yöntem: Çocuk yoğun bakim ünitesine başvuran toplam 202 olgunun (Erkek/Kiz: 101/101; median yaş: 3 [IQR: 9.2]) dosya kayitlari geriye dönük olarak incelendi. Hastalarin yaşi, cinsiyeti, başvuru tanisi, arteriyel kan gazi sonuçlari, hastanede kalma süresi, ve ölüm varliği kaydedildi. Laktat yüksekliği, yaş gruplarina göre düzeylerine göre tanimlandi. Başvuruda laktat yüksekliği olan ve olmayan olgular, ölüm oranlari ve klinik sonuçlar açisindan karşilaştirildi. Bulgular: Başvuruda saptanan hiperlaktatemi sikliği %64.3 (n: 130) idi. Akut gastroenterite bağli dehidratasyon, akut solunumsal yetmezlik ve akut kalp yetmezliği olanlarda laktat düzeyleri diğer tanilarla karşilaştirildiğinda anlamli olarak daha yüksek bulundu. ROC analizi ile mortaliteyi belirleyecek herhangi bir eşik değer saptanmadi (eğri alti alan: 0.57). Ayrica, hiperlaktateminin mortalite ve klinik sonuçla...

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“…On the study of Revelly et al (12) it is commented that patients with cardiogenic shock have a rise in lactate production, but are able to maintain its clearance, which differs from our study. Our sample is small; therefore it had not a statistical significance in the multivariate analysis (11)(12)(13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

“…The best lactate clearance rate is correlated as well with decreased in some biomarker such as interleukins 1,6,8,10, tumor necrosis factor alpha, caspase 3. On the other hand, some studies have demonstrated that normal lactate rates can be found on cardiogenic shock, acute renal failure, and that lactate clearance are altered on these, probably because of multiorgan failure (9,(10)(11)(12)(13)(14)(15)(16). On the majority of studies performed, the effectiveness of lactate clearance determination are compared to predictors mortality scores such as APACHE II, SOFA, SAPS II, concluding that lactate clearance may be by itself a good mortality prognostic factor (12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Lactate Clearance is a Prognostic Factor in Patients on Shock State

et al. 2012

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Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill

Cited by 166 publications

References 26 publications

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

The reasons of hyperlactatemia on admission and relationship of the lactate levels with clinical outcomes in pediatric intensive care unit

Lactate Clearance is a Prognostic Factor in Patients on Shock State

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