The incidence and outcome of severe hyperlactatemia in critically ill patients

Gharipour, Amin; Razavi, Rouzbeh; Gharipour, Mojgan; Modarres, Reza; Nezafati, Pouya; Mirkheshti, Nooshin

doi:10.1007/s11739-020-02337-9

Cited by 32 publications

(30 citation statements)

References 44 publications

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“…Many published studies have shown the association between hyperlactatemia and poor survival of critically ill patients. [5][6][7] Also, in a clinical study by Velavan et al, levels of blood lactate were found significantly elevated in hospitalized COVID-19 patients with severe diseases. 8 Serum albumin that known as one of the major plasma proteins, is a negative acute phase reactant and has anti-oxidant properties.…”

Section: Introductionmentioning

confidence: 89%

“…3,4 The level of serum lactate is the most commonly used biomarker for the management of critically ill patients in the emergency department and intensive care unit (ICU). 5 Hyperlactatemia or elevated levels of serum lactate may be caused by different clinical settings including sepsis, liver diseases, shock, and cancer. Many published studies have shown the association between hyperlactatemia and poor survival of critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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The Lactate/Albumin Ratio As A Prognostic Factor For Short Time Mortality In Critically Ill COVID-19 Patients

Gok¹,

Kasapoğlu²,

Delen³

et al. 2021

Preprint

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Introduction: The prognostic role of the initial lactate/albumin ratio (LAR) in the critically ill COVID-19 patients remains unknown. We aim to evaluate the prognostic value of the initial LAR in predicting 30-days mortality in critically ill COVID-19 patients and compare with the initial level of serum lactate and albumin for the prediction of mortality.Materials and methods: We performed a single-center retrospective and observational clinical study between April 2020 and December 2020. Patients’ clinical and laboratory variables that evaluated in this study were collected within the first 24 hours following the ICU admission.Results: A total of 282 critically ill COVID-19 patients were included in the study. The mean age of the patients was 66.34±12.08 years and 179 (63.5%) of patients were male. Patients who died within 30 days had higher lactate levels (p<0.001), lower levels of serum albumin (p<0.001), and higher levels of LAR (p<0.001). ROC analysis showed that LAR (AUC=0.824) was superior to the serum albumin (AUC=0.644) and lactate levels (AUC=0.795) for the prediction of mortality. Overall ICU mortality rates (75.6% vs 13.1%, p<0.001) were significantly higher in patients with LAR >0.60. LAR >0.60 is a significant and independent prognostic factor for the 30-day mortality in critically ill COVID-19 patients.Conclusion: LAR has a better prognostic performance for predicting 30-day mortality in critically ill COVID-19 patients compared with lactate and albumin

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Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The Lactate/Albumin Ratio As A Prognostic Factor For Short Time Mortality In Critically Ill COVID-19 Patients

Gok¹,

Kasapoğlu²,

Delen³

et al. 2021

Preprint

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“…Hyperlactatemia is considered as a clinical marker of critical illness severity. The association between elevated lactate levels and poor outcome of ICU patients is reported in multiple studies [ 9 ]. Effective lactate clearance seems to be associated with improved outcome [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…However, Recent experimental studies have found that lactate clearance is reduced signi cantly in patients with sepsis, even if hemodynamics remain steady and liver function is normal, which may be related to the decreased activity of pyruvate dehydrogenase [11]. Increased lactate production or decreased clearance will eventually lead to an increase in lactate levels, resulting in hyperlactatemia [12].…”

Section: Introductionmentioning

confidence: 99%

The Combination of Lactate Level, Lactate Clearance and APACHE II Score Better Predicts Short-Term Outcomes in Critically Ill Patients: A Retrospective Cohort Study

Cao

Yao

Shang

et al. 2022

Preprint

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Background The mortality rate is high in critically ill patients due to the difficulty of diagnosis and treatment. Thus, it is very important to explore the predictive value of different indicators related to prognosis in critically ill patients. Methods A retrospective cohort study in Intensive care unit (ICU) of the Sixth People’s Hospital in Shanghai, China. A total of 1465 ICU patients who had lactate values > 2.1 mmol/L at least once within 24 hrs of ICU admission and arterial blood gas monitored more than twice during the ICU stay. Results The predictive value of lactate clearance24hrs was not high, and the sensitivity and specificity were lower. The predictive value of the lactate level at baseline and the APACHE II score was higher than that of lactate clearance24hrs in critically ill patients. The predictive value of the lactate level at baseline combined with the APACHE II score was higher than that of the lactate level at baseline or the APACHE II score alone. In addition, the predictive value of lactate clearance24hrs combined with the APACHE II score was also significantly higher than that of lactate clearance24hrs or the APACHE II score alone. In particular, the area under the ROC reached 0.900, the predictive value was markedly higher than that of the ROC alone, and the sensitivity and specificity were better when these three indicators were combined. Conclusions The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically ill patients.

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The incidence and outcome of severe hyperlactatemia in critically ill patients

Cited by 32 publications

References 44 publications

The Lactate/Albumin Ratio As A Prognostic Factor For Short Time Mortality In Critically Ill COVID-19 Patients

The Lactate/Albumin Ratio As A Prognostic Factor For Short Time Mortality In Critically Ill COVID-19 Patients

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

The Combination of Lactate Level, Lactate Clearance and APACHE II Score Better Predicts Short-Term Outcomes in Critically Ill Patients: A Retrospective Cohort Study

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