Abstract
Background
Many variables measured in critically ill patients have been used to predict patient outcomes; however, it is unlikely that one measurement can replace all, but lactate levels may come close.
Aim
This study aims to evaluate the role of blood lactate level as a predictor of patients’ outcome at Respiratory Intensive Care Unit at Zagazig University Hospitals (RICU-ZUH).
Patients and methods
A prospective cohort study was conducted on 52 patients recruited from RICU-ZUH. All patients’ functional conditions were assessed on admission by the Simplified Acute Physiology Score II scoring system, Glasgow Coma Scale (GCS), and Sequential Organ Failure Assessment scores as well as assessment of sepsis. The blood lactic acid level was measured at H0 (initial blood lactate level), H6, H12, H24, and H48 (in mmol/l). Patients were classified into two groups: (i) normal blood lactate level group, and (ii) hyperlactatemia group. Lactate clearance and lactime were also measured.
Results
Out of the 52 cases studied, hyperlactatemia was present in 30 (57.6%) patients, whereas a normal blood lactate level was found in 22 (42.4%) patients. H0 was significantly high (P<0.01) in the hyperlactatemia group (4.41 ±1.69 mmol/l), with lactime 42.4±10.5 h; also, lactate clearance at H6 was nonsignificantly high (P>0.05). The Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores were significantly positively correlated with H0 and lactime, but significantly negatively correlated with lactate clearance, whereas GCS was negatively correlated in a significant way with H0 and lactime and positively correlated with lactate clearance. The significant highest mortality risk of 2.86 was reported with lactime more than 48 h, followed by a 2.28 risk of mortality with H0 blood lactate level more than 3.9 mmol/l, and the least risk was reported with GCS less than 10.5.
Conclusion
Hyperlactatemia at admission and a prolonged lactime are valuable independent predictors of mortality of RICU patients.
Article PDF
Similar content being viewed by others
References
Bakker J, Nijsten MW, Jansen TC. Clinical use of lactate monitoring in critically ill patients. Ann Intensive Care 2013; 3:12.
Ronco JJ, Fenwick JC, Tweeddale MG, Wiggs BR, Phang PT, Cooper DJ, et al. Identification of the critical oxygen delivery for anaerobic metabolism in critically ill septic and nonseptic humans. JAMA 1993; 270:1724–1730.
Levy B, Gibot S, Franck P, Cravoisy A, Bollaert PE. Relation between muscle Na+K+ ATPase activity and raised lactate concentrations in septic shock: a prospective study. Lancet 2005; 365:871–875.
Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med 2011; 19:74.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270:2957–2963.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2:81–84.
Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/ failure in intensive care units: results of a multicenter, prospective study. Working group on ‘sepsis-related problems’ of the European Society of Intensive Care Medicine. Crit Care Med 1998; 26:1793–1800.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS InternationalSepsisDefinitionsConference. Intensive Care Med 2003; 29:530–538.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med 2013; 41:580–637.
Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 1996; 171:221–226.
Marty PH, Roquilly A, Vallée F, Luzi A, Ferré F, Fourcade O, et al. Lactate clearance for death prediction in severe sepsis or septic shock patients during the first 24 h in intensive care unit: an observational study. Ann Intensive Care 2013; 3:3.
Régnier MA, Raux M, Le Manach Y, Asencio Y, Gaillard J, Devilliers C, et al. Prognostic significance of blood lactate and lactate clearance in trauma patients. Anesthesiology 2012; 117:1276–1288.
Dunne JR, Tracy JK, Scalea TM, Napolitano LM. Lactate and base deficit in trauma: does alcohol or drug use impair their predictive accuracy? J Trauma 2005; 58:959–966.
Aduen J, Bernstein WK, Khastgir T, Miller J, Kerzner R, Bhatiani A, et al. The use and clinical importance of a substrate-specific electrode for rapid determination of blood lactate concentrations. JAMA 1994; 272: 1678–1685.
Brinkert W, Rommes JH, Bakker J. Lactate measurements in critically ill patients with a hand-held analyser. Intensive Care Med 1999; 25:966–969.
Weil MH, Michaels S, Rackow EC. Comparison of blood lactate concentrations in central venous, pulmonary artery, and arterial blood. Crit Care Med 1987; 15:489–490.
Fauchere JC, Bauschatz AS, Arlettaz R, Zimmermann-Bar U, Bucher HU. Agreement between capillary and arterial lactate in the newborn. Acta Paediatr 2002, 91:78–81.
Van Beest PA, Lukas B, Sebastiaan PA, Johannes HR, Michaël AK, Peter ES. Cumulative lactate and hospital mortality in ICU patients. Ann Intensive Care 2013; 3:6.
Zhang Z, Chen K, Ni H, Fan H. Predictive value of lactate in unselected critically ill patients: an analysis using fractional polynomials. J Thorac Dis 2014; 6:995–1003.
Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 2004; 32:1637–1642.
Yolbaş I, şen V, Boşnak M, Kelekçi S, Yel S, Güneş A. The relationship between blood lactate levels and mortality in pediatric intensive care patients. J Clin Exp Invest 2013; 4:289–292.
Pasha A, Rao N, Prabodh S, Sripad DV, Chowdary NVS. Relationship between serum lactate levels and fatal outcome in critically ill patients: a prospective study in intensive care unit. Int J Sci Stud 2015; 2:61–63.
Badreldin AM, Doerr F, Elsobky S, Brehm BR, Abul-Dahab M, Lehmann T, et al. Mortality prediction after cardiac surgery: blood lactate is indispensible. Thorac Cardiovasc Surg 2013; 61:708–717.
Maarslet L, Møller MB, Dall R, Hjortholm K, Ravn H. Lactate levels predict mortality and need for peritoneal dialysis in children undergoing congenital heart surgery. Acta Anaesthesiol Scand 2012; 56:459–464.
Hajjar LA, Almeida JP, Fukushima JT, Rhodes A, Vincent JL, Osawa EA, et al. High lactate levels are predictors of major complications after cardiac surgery. J Thorac Cardiovasc Surg 2013; 146:455–460.
Puskarich MA, Trzeciak S, Shapiro NI, Albers AB, Heffner AC, Kline JA, et al. Whole blood lactate kinetics in patients undergoing quantitative resuscitation for severe sepsis and septic shock. Chest 2013; 143:1548–1553.
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; 182:752–761.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Hussein, R.M., El-Shahat, H.M., Mansour, W. et al. Blood lactate level as a predictor of patients’ outcome at the Respiratory Intensive Care Unit of Zagazig University Hospitals. Egypt J Bronchol 11, 128–133 (2017). https://doi.org/10.4103/ejb.ejb_64_16
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/ejb.ejb_64_16