Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study

Abstract

IntroductionHigher lactate concentrations within the normal reference range (relative hyperlactatemia) are not considered clinically significant. We tested the hypothesis that relative hyperlactatemia is independently associated with an increased risk of hospital death.MethodsThis observational study examined a prospectively obtained intensive care database of 7,155 consecutive critically ill patients admitted to the Intensive Care Units (ICUs) of four Australian university hospitals. We assessed the relationship between ICU admission lactate, maximal lactate and time-weighted lactate levels and hospital outcome in all patients and also in those patients whose lactate concentrations (admission n = 3,964, maximal n = 2,511, and time-weighted n = 4,584) were under 2 mmol.L-1 (i.e. relative hyperlactatemia).ResultsWe obtained 172,723 lactate measurements. Higher admission and time-weightedlactate concentration within the reference range was independently associated with increased hospital mortality (admission odds ratio (OR) 2.1, 95% confidence interval (CI) 1.3 to 3.5, P = 0.01; time-weighted OR 3.7, 95% CI 1.9 to 7.00, P < 0.0001). This significant association was first detectable at lactate concentrations > 0.75 mmol.L-1. Furthermore, in patients whose lactate ever exceeded 2 mmol.L-1, higher time-weighted lactate remained strongly associated with higher hospital mortality (OR 4.8, 95% CI 1.8 to 12.4, P < 0.001).ConclusionsIn critically ill patients, relative hyperlactataemia is independently associated with increased hospital mortality. Blood lactate concentrations > 0.75 mmol.L-1 can be used by clinicians to identify patients at higher risk of death. The current reference range for lactate in the critically ill may need to be re-assessed.

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

“…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.…”

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

“…Some reports suggest that a lactate level of greater than 4 mmol/L, instead of 2 mmol/L, should be used to define hyperlactatemia to predict death [29]. Nichol et al [30], reported that high blood lactate concentrations within the current reference range were also associated with increased hospital mortality. In our study group, admission hyperlactatemia was not found to have a cutoff value to predict mortality by ROC analysis (Area under curve:0.57) (Figure 1).…”

Pathophysiology and management of different types of shock

“…This will enable glycolysis, and the accompanying ATP production to proceed. (5) In other cases, lactic acidosis occurs because of an impairment in tissue oxygen utilization, as in septic shock and post resuscitation from cardiac arrest; a normal Smvo2 with an elevated lactate indicates such an impairment. Elevated lactate is a marker of impaired oxygen delivery and/or utilization and correlates with short-term prognosis of critically ill patients in the ED.Smvo2 can also be used as a measure of the balance between tissue oxygen supply and demand.…”