Lactate Levels As A Prognostic Indicator In Heterogeneous ICU Population
Keywords:
APACHE, Lactate, In-hospital mortality, heterogeneous ICU population.
Abstract
Background: The period course of blood lactate levels could be supportive to evaluate a patient’s response to therapy. Serial blood lactate levels in different groups of acutely ill patients.Methods: A total of 200 patients admitted to ICU with critical illness were randomly selected for the study group, Relevant demographic information, clinical history, clinical and laboratory parameters including diagnosis and length of ICU stay were recorded from each patient. The first sample was taken on admission the other samples was taken on 2nd, 3rd and 4th day of admission. Serial arterial sample lactate measurement was done from the patients to note the initial level, time of maximal level and level at time to normal.Result: In the study population 27.5% belonged to the age group of 40-49 years followed by 24% in the age group 50-59 and 20.5% in 60-69 yrs. 57% patients were males and 43% were females. 20.5% patients expired 34.5% patients had hyperlactatemia during ICU stay out of which 31.9% patients expired.Conclusion: Elevated lactate is encountered in a multitude of clinical presentations. Hyperlactatemia is associated with an in-hospital mortality in a heterogeneous ICU population. Patients with elevated lactate levels predicted in hospital mortality and also normalization of lactate within 6 hours is associated with lower mortality. The observation of a better outcome associated with decreasing blood lactate concentrations was consistent throughout the clinical study. Lactate level is an easily measured laboratory parameter which can provide useful information for the bedside clinician when incorporated into the apt clinical milieu. DOI: 10.21276/AAMS.1743References
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2. Puskarich MA, Trzeciak S, Shapiro NI, et al. Prognostic value and agreement of achieving lactate clearance or central venous oxygen saturation goals during early sepsis resuscitation. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine. Mar; 2012 19(3):252–258.
3. Nguyen HB, Kuan WS, Batech M, et al. Outcome effectiveness of the severe sepsis resuscitation bundle with addition of lactate clearance as a bundle item: a multinational evaluation. Crit Care. 2011; 15(5): R229.
4. Consoli A, Nurjhan N, Reilly JJ Jr. Bier DM, Gerich JE. Contribution of liver and skeletal muscle to alanine and lactate metabolism in humans. The American journal of physiology. Nov; 1990 259(5 Pt 1):E677–684.
5. Connor H, Woods HF, Ledingham JG, Murray JD. A model of L (+)-lactate metabolism in normal man. Annals of nutrition & metabolism. 1982; 26(4):254–263.
6. Blum A, Zoubi AA, Kuria S, Blum N. High serum lactate level may predict death within 24 hours. Open Medicine. 2015;10(1):318-322. doi:10.1515/med-2015-0045.
7. Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Critical Care. 2009;13(3):R90. doi:10.1186/cc7918.
8. Shapiro NI1, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, Weiss JW. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45(5):524-528.
9. Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 2004;32(8):1637-1642
10. Claridge JA, Crabtree TD, Pelltier SJ, et al. Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients. J Trauma 2000;48(1):8-14
11. Jansen TC, van BJ, Mulder PG, et al. Prognostic value of blood lactate levels: does the clinical diagnosis at admission matter? J Trauma 2009;66(2):377-385.
12. Nichol AD, Egi M, Pettila V, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Critical Care. 2010;14(1):R25. doi:10.1186/cc8888.
13. Haas SA, Lange T, Saugel B, Petzoldt M, Fuhrmann V, Metschke M, Kluge S. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med. 2016 Feb;42(2):202-10. doi: 10.1007/s00134-015-4127-0.
14. Bramson D, Scalea TM, Hitchcock R, et al. Lactate clearance and survival following injury. J Trauma. 1993;35(4):584–588.
15. Blow O, Magliore L, Claridge JA, et al. The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma. 1999;47(5):964–969.
16. Onnino MW, Miller J, Goyal N, et al. Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients. Resuscitation. 2007;75(2):229–234.
17. Vincent JL, Dufaye P, Berre J, et al. Serial lactate determinations during circulatory shock. Crit Care Med. 1983;11(6):449–451.
18. Scott S, Antonaglia V, Guiotto G, et al. Two-hour lactate clearance predicts negative outcome in patients with cardiorespiratory insufficiency. Crit Care Res Pract. 2010;917053
19. Bhat SR, Swenson KE, Francis MW, Wira CR. Lactate Clearance Predicts Survival Among Patients in the Emergency Department with Severe Sepsis. Western Journal of Emergency Medicine. 2015;16(7):1118-1126.
20. Jansen TC, vanbommel J, Schhoonderbeek FJ 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: 752-761.
21. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-829.
22. Chen SJ, Chao TF, Chiang MC, Kuo SC, Chen LY, Yin T, et al. Prediction of patient outcome from Acinetobacter baumannii bacteremia with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Intern Med. 2011;50:871–877.
23. Qiao Q, Lu G, Li M, Shen Y, Xu D. Prediction of outcome in critically ill elderly patients using APACHE II and SOFA scores. J Int Med Res. 2012; 40:1114–1121.
24. Sawicka W, Owczuk R, Wujtewicz MA, Wujtewicz M. The effectiveness of the APACHE II, SAPS II and SOFA prognostic scoring systems in patients with haematological malignancies in the intensive care unit. Anesthesiol Intensive Ther. 2014; 46:166–170.
25. Gallagher EJ, Rodriguez K, Touger M. Agreement between peripheral venous and arterial lactate levels. Ann Emerg Med 1997; 29:479-483.
26. Shapiro NI, Fisher C, Donnino M, Cataldo L, Tang A, Trzeciak S, et al. The feasibility and accuracy of point-of-care lactate measurement in emergency department patients with suspected infection. J Emerg Med 2010; 39:89-94.
27. Goyal M, Pines JM, Drumheller BC, Gaieski DF. Point-of-care testing at triage decreases time to lactate level in septic patients. J Emerg Med 2010; 38:578-581.
2. Puskarich MA, Trzeciak S, Shapiro NI, et al. Prognostic value and agreement of achieving lactate clearance or central venous oxygen saturation goals during early sepsis resuscitation. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine. Mar; 2012 19(3):252–258.
3. Nguyen HB, Kuan WS, Batech M, et al. Outcome effectiveness of the severe sepsis resuscitation bundle with addition of lactate clearance as a bundle item: a multinational evaluation. Crit Care. 2011; 15(5): R229.
4. Consoli A, Nurjhan N, Reilly JJ Jr. Bier DM, Gerich JE. Contribution of liver and skeletal muscle to alanine and lactate metabolism in humans. The American journal of physiology. Nov; 1990 259(5 Pt 1):E677–684.
5. Connor H, Woods HF, Ledingham JG, Murray JD. A model of L (+)-lactate metabolism in normal man. Annals of nutrition & metabolism. 1982; 26(4):254–263.
6. Blum A, Zoubi AA, Kuria S, Blum N. High serum lactate level may predict death within 24 hours. Open Medicine. 2015;10(1):318-322. doi:10.1515/med-2015-0045.
7. Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Critical Care. 2009;13(3):R90. doi:10.1186/cc7918.
8. Shapiro NI1, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, Weiss JW. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45(5):524-528.
9. Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 2004;32(8):1637-1642
10. Claridge JA, Crabtree TD, Pelltier SJ, et al. Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients. J Trauma 2000;48(1):8-14
11. Jansen TC, van BJ, Mulder PG, et al. Prognostic value of blood lactate levels: does the clinical diagnosis at admission matter? J Trauma 2009;66(2):377-385.
12. Nichol AD, Egi M, Pettila V, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Critical Care. 2010;14(1):R25. doi:10.1186/cc8888.
13. Haas SA, Lange T, Saugel B, Petzoldt M, Fuhrmann V, Metschke M, Kluge S. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med. 2016 Feb;42(2):202-10. doi: 10.1007/s00134-015-4127-0.
14. Bramson D, Scalea TM, Hitchcock R, et al. Lactate clearance and survival following injury. J Trauma. 1993;35(4):584–588.
15. Blow O, Magliore L, Claridge JA, et al. The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma. 1999;47(5):964–969.
16. Onnino MW, Miller J, Goyal N, et al. Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients. Resuscitation. 2007;75(2):229–234.
17. Vincent JL, Dufaye P, Berre J, et al. Serial lactate determinations during circulatory shock. Crit Care Med. 1983;11(6):449–451.
18. Scott S, Antonaglia V, Guiotto G, et al. Two-hour lactate clearance predicts negative outcome in patients with cardiorespiratory insufficiency. Crit Care Res Pract. 2010;917053
19. Bhat SR, Swenson KE, Francis MW, Wira CR. Lactate Clearance Predicts Survival Among Patients in the Emergency Department with Severe Sepsis. Western Journal of Emergency Medicine. 2015;16(7):1118-1126.
20. Jansen TC, vanbommel J, Schhoonderbeek FJ 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: 752-761.
21. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-829.
22. Chen SJ, Chao TF, Chiang MC, Kuo SC, Chen LY, Yin T, et al. Prediction of patient outcome from Acinetobacter baumannii bacteremia with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Intern Med. 2011;50:871–877.
23. Qiao Q, Lu G, Li M, Shen Y, Xu D. Prediction of outcome in critically ill elderly patients using APACHE II and SOFA scores. J Int Med Res. 2012; 40:1114–1121.
24. Sawicka W, Owczuk R, Wujtewicz MA, Wujtewicz M. The effectiveness of the APACHE II, SAPS II and SOFA prognostic scoring systems in patients with haematological malignancies in the intensive care unit. Anesthesiol Intensive Ther. 2014; 46:166–170.
25. Gallagher EJ, Rodriguez K, Touger M. Agreement between peripheral venous and arterial lactate levels. Ann Emerg Med 1997; 29:479-483.
26. Shapiro NI, Fisher C, Donnino M, Cataldo L, Tang A, Trzeciak S, et al. The feasibility and accuracy of point-of-care lactate measurement in emergency department patients with suspected infection. J Emerg Med 2010; 39:89-94.
27. Goyal M, Pines JM, Drumheller BC, Gaieski DF. Point-of-care testing at triage decreases time to lactate level in septic patients. J Emerg Med 2010; 38:578-581.
Published
2017-12-09
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