Relationship between Serum Lactate Levels and Fatal Outcome in Critically Ill Patients: A Prospective Study in Intensive Care Unit
Abstract
Introduction: Blood lactate levels are suggested as more important parameter to evaluate patient condition particularly in
critical illness.
Aim: The aim of this study is to fi nd a relation between lactate levels and hospital fatal outcome in critical illness.
Methods: This was a prospective observational study in 125 critical ill-patients admitted in intensive care unit. Serial serum
lactate levels were estimated from the time of admission for every 24 h and the results were correlated with Acute Physiology
and Chronic Health Evaluation II (APACHE) score and fatal outcome.
Results: Non-survivors (n = 32, 25%) had signifi cantly higher lactate levels than survivors at the time of admission (137.5 mg/dl
vs. 37.7 mg/dl). Fatal outcome rate was signifi cantly higher in patients with lactate levels 100 mg/dl or higher when compared
with lactate levels below 100 mg/dl. A signifi cant positive correlation was observed between APACHE II scores and admission
lactate levels in nonsurvivors.
Conclusion: Serum lactate measurement plays a signifi cant role in detection of fatal outcome in critical illness patients.
References
levels can predict the development of multiple organ failure following
septic shock. Am J Surg 1996;171:221-6.
2. Brooks GA. Cell-cell and intracellular lactate shuttles. J Physiol
2009;587:5591-600.
3. Stacpoole PW, Wright EC, Baumgartner TG, Bersin RM, Buchalter S,
Curry SH, et al. Natural history and course of acquired lactic acidosis in
adults. DCA-Lactic Acidosis Study Group. Am J Med 1994;97:47-54.
4. Handy J. Lactate – The bad boy of metabolism, or simply misunderstood?
Curr Anaesth Crit Care 2006;17:71-6.
5. Abramson D, Scalea TM, Hitchcock R, Trooskin SZ, Henry SM, Greenspan
J. Lactate clearance and survival following injury. J Trauma 1993;35:584-8.
6. Donati A, Cornacchini O, Loggi S, Caporelli S, Conti G, Falcetta S, et al.
A comparison among portal lactate, intramucosal sigmoid Ph, and deltaCO2
(PaCO2 - regional Pco2) as indices of complications in patients undergoing
abdominal aortic aneurysm surgery. Anesth Analg 2004;99:1024-31.
7. Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL. Serum
lactate and base defi cit as predictors of mortality in normotensive elderly
blunt trauma patients. J Trauma 2009;66:1040-4.
8. Mizok BA. Redox repairs, tissue hypoxia, organ dysfunction and mortality.
Crit Care Med 2000;28:270-2.
9. Tuchschmidt J, Fried J, Swinney R, Sharma OP. Early hemodynamic
correlates of survival in patients with septic shock. Crit Care Med
1989;17:719-23.
10. Weil MH, Afi fi AA. Experimental and clinical studies on lactate and
pyruvate as indicators of the severity of acute circulatory failure (shock).
Circulation 1970;41:989-1001.
11. Bakker J, Coffernils M, Leon M, Gris P, Vincent JL. Blood lactate levels are
superior to oxygen-derived variables in predicting outcome in human septic
shock. Chest 1991;99:956-62.
12. van Beest PA, Brander L, Jansen SP, Rommes JH, Kuiper MA, Spronk PE.
Cumulative lactate and hospital mortality in ICU patients. Ann Intensive
Care 2013;3:6.
13. Druml W, Grimm G, Laggner AN, Lenz K, Schneeweiss B. Lactic acid
kinetics in respiratory alkalosis. Crit Care Med 1991;19:1120-4.
14. Levraut J, Ciebiera JP, Chave S, Rabary O, Jambou P, Carles M, et al. Mild
hyperlactatemia in stable septic patients is due to impaired lactate clearance
rather than overproduction. Am J Respir Crit Care Med 1998;157:1021-6.
15. Huckabee WE. Abnormal resting blood lactate. I. The signifi cance of
hyperlactatemia in hospitalized patients. Am J Med 1961;30:840-8.
16. Andersen O, Haugaard SB, Jørgensen LT, Sørensen S, Nielsen JO,
Madsbad S, et al. Preanalytical handling of samples for measurement of
plasma lactate in HIV patients. Scand J Clin Lab Invest 2003;63:449-54.
17. Jansen TC, van Bommel J, Bakker J. Blood lactate monitoring in critically
ill patients: A systematic health technology assessment. Crit Care Med
2009;37:2827-39.
18. Toraman F, Evrenkaya S, Yuce M, Aksoy N, Karabulut H, Bozkulak Y, et al.
Lactic acidosis after cardiac surgery is associated with adverse outcome.
Heart Surg Forum 2004;7:E155-9.
19. Cerović O, Golubović V, Spec-Marn A, Kremzar B, Vidmar G. Relationship
between injury severity and lactate levels in severely injured patients.
Intensive Care Med 2003;29:1300-5.
20. Husain FA, Martin MJ, Mullenix PS, Steele SR, Elliott DC. Serum lactate
and base defi cit as predictors of mortality and morbidity. Am J Surg
2003;185:485-91.
21. Deshpande SA, Platt MP. Association between blood lactate and acid-base
status and mortality in ventilated babies. Arch Dis Child Fetal Neonatal Ed
1997;76:F15-20.
22. Park M, Azevedo LC, Maciel AT, Pizzo VR, Noritomi DT, da Cruz Neto
LM. Evolutive standard base excess and serum lactate level in severe sepsis
and septic shock patients resuscitated with early goal-directed therapy: Still
outcome markers? Clinics (Sao Paulo) 2006;61:47-52.
23. Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der
Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care
unit patients: A multicenter, open-label, randomized controlled trial. Am J
Respir Crit Care Med 2010;182:752-61.
Publisher: 