Prognostic Value of Blood Lactate Levels: Does the Clinical Diagnosis at Admission Matter?

Tim Jansen, Jasper van Bommel, PGH (Paul) Mulder, AP de Lima, Ben van der Hoven, JH Rommes, FTF Snellen, Jan Bakker

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Abstract

Background: Hyperlactatemia and its reduction after admission in the intensive care unit (ICU) have been related to survival. Because it is unknown whether this equally applies to different groups of critically ill patients, we compared the prognostic value of repeated lactate levels (a) in septic patients versus patients with hemorrhage or other conditions generally associated with low-oxygen transport (LT) (b) in hemodynamically stable versus unstable patients. Methods: In this prospective observational two-center study (n = 394 patients), blood lactate levels at admission to the ICU (LaCT0) and the reduction of lactate levels from T = 0 to T = 12 hours (Delta Lac(ro-12)) and from T = 12 to T = 24 hours (Delta Lac(T-12-24)), were related to in-hospital mortality. Results: Reduction of lactate was associated with a lower mortality only in the sepsis group (Delta Lac(T0-12): hazard ratio [HR] 0.34, p = 0.004 and Delta Lac(T12-24): HR 0.24, p = 0.003), but not in the LT group (Delta Lac(T0-12); HR 0.78, p = 0.52 and Delta Lac(r12-24); HR 1.30, p = 0.61). The prognostic values of Lac(T0,) Delta Lacr(0-12) and Delta Lac(T12-24) were similar in hemodynamically stable and unstable patients (p = 0.43). Conclusions: Regardless of the hemodynamic status, lactate reduction during the first 24 hours of ICU stay is associated with improved outcome only in septic patients, but not in patients with hemorrhage or other conditions generally associated with LT. We hypothesize that in this particular group a reduction in lactate is not associated with improved outcome due to irreversible damage at ICU admission.
Original languageUndefined/Unknown
Pages (from-to)377-385
Number of pages9
JournalJournal of Trauma-Injury Infection and Critical Care
Volume66
Issue number2
DOIs
Publication statusPublished - 2009

Research programs

  • EMC COEUR-09
  • EMC NIHES-01-66-01

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