Severe hyperlactatemia in unselected surgical patients: retrospective analysis of prognostic outcome factors

Abstract

Background Etiology of hyperlactatemia in ICU patients is heterogeneous—septic, cardiogenic or hemorrhagic shock seem to be predominant reasons. Multiple studies show hyperlactatemia as an independent predictor for ICU mortality. Only limited data exists about the etiology of hyperlactatemia and lactate clearance and their influence on mortality. The goal of this single-center retrospective study, was to evaluate the effect of severe hyperlactatemia and reduced lactate clearance rate on the outcome of unselected ICU surgical patients. Methods Overall, 239 surgical patients with severe hyperlactatemia (> 10 mmol/L) who were treated in the surgical ICU at the University Medical Center Freiburg between June 2011 and August 2017, were included in this study. The cause of the hyperlactatemia as well as the postoperative course and the patient morbidity and mortality were retrospectively analyzed. Lactate clearance was calculated by comparing lactate level 12 h after first measurement of > 10 mmol/L. Results The overall mortality rate in our cohort was 82.4%. Severe hyperlactatemia was associated with death in the ICU (p < 0.001). The main etiologic factor was sepsis (51.9%), followed by mesenteric ischemia (15.1%), hemorrhagic shock (13.8%) and liver failure (9.6%). Higher lactate levels at ICU admission were associated with increased mortality (p < 0.001). Lactate clearance after 12 h was found to predict ICU mortality (ANOVA p < 0.001) with an overall clearance of under 50% within 12 h. The median percentage of clearance was 60.3% within 12 h for the survivor and 29.1% for the non-survivor group (p < 0.001). Conclusion Lactate levels appropriately reflect disease severity and are associated with short-term mortality in critically ill patients. The main etiologic factor for surgical patients is sepsis. When elevated lactate levels persist more than 12 h, survival chances are low and the benefit of continued maximum therapy should be evaluated.

Prognostic Value of Hyperlactatemia and Lactate Clearance in Septic Patients With Hematological Malignancies

“…It was observed that nonsurvivors presented with higher lactate levels at 0, 6th, and 12th hours compared to survivors. This result indicates a potential association between elevated lactate and adverse outcomes, similar to those observed in prior studies (11)(12)(13). The observed pattern of hyperlactatemia frequency over the rst 24 hours, with a decline from 64-36%, indicates the dynamic nature of lactate levels in this population.…”

Could lactate clearance be a marker of mortality in pediatric intensive care unit?

“…These studies have demonstrated that serum lactate levels hold a crucial role in risk-stratification in critically ill patients. It is reported during the initial stage of treatment, lactate levels seem to be more closely associated with the outcome compared to frequently measured parameters such as oxygen delivery and oxygen consumption [ 3 , 4 , 8 , 14 ].…”

Prevalence and predictors of outcomes among ESRD patients with COVID-19

“…Nonetheless, these studies only analyzed one to two months of data and retrieved data from a single site in different places, which were New York or the Alborz province in Iran [11,12]. Furthermore, hyperlactatemia has traditionally been a marker of poor prognosis in critically ill patients [13]. In our study, ESRD patients had 3.19 higher odds for having elevated lactate levels and 2.12 higher odds for ≥ 7 days of hospital stay.…”

“…Furthermore, hyperlactatemia has traditionally been a marker of poor prognosis in critically ill patients [ 13 ]. In our study, ESRD patients had 3.19 higher odds for having elevated lactate levels and 2.12 higher odds for ≥ 7 days of hospital stay.…”