- Infection
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Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock
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Surat Tongyoo, Kamonlawat Sutthipool, Tanuwong Viarasilpa, Chairat Permpikul
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Acute Crit Care. 2022;37(1):108-117. Published online November 26, 2021
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DOI: https://doi.org/10.4266/acc.2021.00332
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 Abstract
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- Background
In septic shock patients with cirrhosis, impaired liver function might decrease lactate elimination and produce a higher lactate level. This study investigated differences in initial lactate, lactate clearance, and lactate utility between cirrhotic and non-cirrhotic septic shock patients.
Methods
This is a retrospective cohort study conducted at a referral, university-affiliated medical center. We enrolled adults admitted during 2012–2018 who satisfied the septic shock diagnostic criteria of the Surviving Sepsis Campaign: 2012. Patients previously diagnosed with cirrhosis by an imaging modality were classified into the cirrhosis group. The initial lactate levels and levels 6 hours after resuscitation were measured and used to calculate lactate clearance. We compared initial lactate, lactate at 6 hours, and lactate clearance between the cirrhosis and non-cirrhosis groups. The primary outcome was in-hospital mortality.
Results
Overall 777 patients were enrolled, of whom 91 had previously been diagnosed with cirrhosis. Initial lactate and lactate at 6 hours were both significantly higher in cirrhosis patients, but there was no difference between the groups in lactate clearance. A receiver operating characteristic curve analysis for predictors of in-hospital mortality revealed cut-off values for initial lactate, lactate at 6 hours, and lactate clearance of >4 mmol/L, >2 mmol/L, and <10%, respectively, among non-cirrhosis patients. Among patients with cirrhosis, the cut-off values predicting in-hospital mortality were >5 mmol/L, >5 mmol/L, and <20%, respectively. Neither lactate level nor lactate clearance was an independent risk factor for in-hospital mortality among cirrhotic and non-cirrhotic septic shock patients.
Conclusions
The initial lactate level and lactate at 6 hours were significantly higher in cirrhosis patients than in non-cirrhosis patients.
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Citations
Citations to this article as recorded by  - Comparison between traditional logistic regression and machine learning for predicting mortality in adult sepsis patients
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Thomas N. Smith, Chansong Choi, Puru Rattan, Laura Piccolo Serafim, Blake A. Kassmeyer, Ryan J. Lennon, Ognjen Gajic, Jody C. Olson, Patrick S. Kamath, Alice Gallo De Moraes, Douglas A. Simonetto
Hepatology Communications.2024;[Epub] CrossRef - Review article: Evaluation and care of the critically ill patient with cirrhosis
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