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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
  • 12,554 View
  • 288 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract PDFSupplementary Material
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  
  • Comparison between traditional logistic regression and machine learning for predicting mortality in adult sepsis patients
    Hongsheng Wu, Biling Liao, Tengfei Ji, Keqiang Ma, Yumei Luo, Shengmin Zhang
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • Development and external validation of an artificial intelligence model for predicting mortality and prolonged ICU stay in postoperative critically ill patients: a retrospective study
    Dong Jin Park, Seung Min Baik, Kyung Sook Hong, Heejung Yi, Jae Gil Lee, Jae-Myeong Lee
    World Journal of Emergency Surgery.2025;[Epub]     CrossRef
  • Evaluating the diagnostic performance of adult sepsis event criteria in the emergency department: impact of including isolated serum lactate elevations
    Hyojun Park, Ryoung-Eun Ko, Hyo-Seok Oh, Jae Young Moon, Youjin Chang, Gee Young Suh
    Journal of Intensive Care.2025;[Epub]     CrossRef
  • A Rare Case of Drug-Induced Liver Injury Due to Metformin and Literature Review
    清正 刘
    Advances in Clinical Medicine.2025; 15(09): 472.     CrossRef
  • Comparison of the accuracy of predictive models in early detection of clinically relevant posthepatectomy liver failure
    Ying Li, Yu-Meng Liu, Yu-Lin Gao, Zun-Qiang Xiao, Lei Jin, Jun-Wei Liu, Xiao-Dong Sun, Yi Lu
    BMC Cancer.2025;[Epub]     CrossRef
  • 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
  • Review article: Evaluation and care of the critically ill patient with cirrhosis
    Iva Kosuta, Madhumita Premkumar, K. Rajender Reddy
    Alimentary Pharmacology & Therapeutics.2024; 59(12): 1489.     CrossRef
  • Diagnostic Value of Endotoxin Activity for Acute Postoperative Complications: A Study in Major Abdominal Surgery Patients
    Hye Sung Kim, Gyeo Ra Lee, Eun Young Kim
    Biomedicines.2024; 12(12): 2701.     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
  • 4,909 View
  • 38 Download
  • 1 Crossref
AbstractAbstract 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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