Acute and Critical Care

Original Articles

Infection
Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock: Surat Tongyoo, Kamonlawat Sutthipool, Tanuwong Viarasilpa, Chairat Permpikul; Acute Crit Care. 2022;37(1):108-117. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00332

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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.

Citations

Citations to this article as recorded by

Serum lactate and mean arterial pressure thresholds in patients with cirrhosis and septic shock
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
Norepinephrine dose, lactate or heart rate: what impacts prognosis in sepsis and septic shock? Results from a prospective, monocentric registry
Tobias Schupp, Kathrin Weidner, Jonas Rusnak, Schanas Jawhar, Jan Forner, Floriana Dulatahu, Lea Marie Brück, Ursula Hoffmann, Thomas Bertsch, Ibrahim Akin, Michael Behnes
Current Medical Research and Opinion.2023; 39(5): 647. CrossRef
Intensive care management of acute-on-chronic liver failure
Giovanni Perricone, Thierry Artzner, Eleonora De Martin, Rajiv Jalan, Julia Wendon, Marco Carbone
Intensive Care Medicine.2023; 49(8): 903. CrossRef

The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock: Jung Hwan Ahn, Sang Cheon Choi, Young Gi Min, Yoon Seok Jung, Sung Hee Chung, Young Joo Lee; Korean J Crit Care Med. 2009;24(3):134-139.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.134

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Abstract PDF

BACKGROUND
The lactate concentration should be used to examine the severity of sepsis or any state of shock. This study was conducted to investigate the prognostic power of the lactate clearance, as adjusted for time, between the survivors and nonsurvivors of patients with severe sepsis or septic shock.
METHODS
The study was performed on 67 patients over 16 years old and who were admitted to the intensive care unit (ICU) with severe sepsis or septic shock. They were divided into the survivors (n = 37) and nonsurvivors (n = 30). The blood lactate concentrations were assayed at intervals ranging from 8 to 24 hours and the APACHE III scoring was done daily for 2 weeks or until discharge or death. The lactate clearance, as adjusted for time, was defined using the following formula: [(the maximal lactate concentration - the normal lactate concentration)/the time to normalize the lactate concentration] x 1,000.
RESULTS
There were no significant differences of age, gender and the length of the ICU stay between the survivors and non-survivors. There were significant difference of the time to measuring the maximal serum lactate concentration (3.2 +/- 12.3 hours vs. 28.8 +/- 64.6 hours, respectively; p = 0.037), the lactate clearance, as adjusted for time (132.27 +/- 112.88 mol/L . hour vs. 59.67 +/- 72.60 mol/L . hour, respectively; p = 0.002), the lactate clearance during 24 hours (46.0 +/- 26.3% vs. 22.6 +/- 45.6%, respectively; p = 0.018) and the APACHE III score (67.6 +/- 22.7 vs. 83.9 +/- 21.6, respectively; p = 0.005) between the survivors and non-survivors. The lactate clearance, as adjusted for time and the APACHE III score were the predictive factors for survival on the logistic regression analysis (odd ratio 0.987; p = 0.028 vs. odd ratio 1.046; p = 0.006).
CONCLUSIONS
Lactate clearance, as adjusted for time, could be used as a prognostic index, as well as the APACHE III score, for patients with severe sepsis or septic shock.

Citations

Citations to this article as recorded by

Lactate Clearance and Outcome in Septic Shock Patients with Low Level of Initial Lactate
Yun Su Sim, Cho Rom Hahm, So Yeon Lim, Gee Young Suh, Kyeongman Jeon
The Korean Journal of Critical Care Medicine.2011; 26(2): 78. CrossRef

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