Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock
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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.
Abstract
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.
참고문헌 (25)
- Kethireddy S, "Culture-negative septic shock compared with culture-positive septic shock : a retrospective cohort study", Crit Care Med, 46, pp.506~512 (2018)
- Shankar-Hari M, "Developing a new definition and assessing new clinical criteria for septic shock : for the third international consensus definitions for sepsis and septic shock(Sepsis-3)", JAMA, 315, pp.775~787 (2016)
- Permpikul C, "Impact of septic shock hemodynamic resuscitation guidelines on rapid early volume replacement and reduced mortality", J Med Assoc Thai, 93(Suppl 1), pp.S102~S109 (2010)
- Singer M, "The third international consensus definitions for sepsis and septic shock(Sepsis-3)", JAMA, 315, pp.801~810 (2016)
- Jones AE, "Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy : a randomized clinical trial", JAMA, 303, pp.739~746 (2010)
- Permpikul C, "Therapeutic goal achievements during severe sepsis and septic shock resuscitation and their association with patients’ outcomes", J Med Assoc Thai, 97(Suppl 3), pp.S176~S183 (2014)
- Permpikul C, "Early use of norepinephrine in septic shock resuscitation(CENSER) : a randomized trial", Am J Respir Crit Care Med, 199, pp.1097~1105 (2019)
- Jansen TC, "Early lactate-guided therapy in intensive care unit patients : a multicenter, open-label, randomized controlled trial", Am J Respir Crit Care Med, 182, pp.752~761 (2010)
- Ryoo SM, "Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by sepsis-3", Crit Care Med, 46, pp.e489~e495 (2018)
- Promsin P, "Optimal cut-offfor hourly lactate reduction in ICU-treated patients with septic shock", Acta Anaesthesiol Scand, 63, pp.885~894 (2019)
- Kraut JA, "Lactic acidosis", N Engl J Med, 371, pp.2309~2319 (2014)
- Fall PJ, "Lactic acidosis : from sour milk to septic shock", J Intensive Care Med, 20, pp.255~271 (2005)
- Fuller BM, "Lactate as a hemodynamic marker in the critically ill", Curr Opin Crit Care, 18, pp.267~272 (2012)
- Garcia-Alvarez M, "Sepsis-associated hyperlactatemia", Crit Care, 18, pp.503~ (2014)
- Dellinger RP, "Surviving sepsis campaign : international guidelines for management of severe sepsis and septic shock : 2012", Crit Care Med, 41, pp.580~637 (2013)
- Pattharanitima P, "Correlation of arterial, central venous and capillary lactate levels in septic shock patients", J Med Assoc Thai, 94(Suppl 1), pp.S175~S180 (2011)
- Youden WJ, "Index for rating diagnostic tests", Cancer, 3, pp.32~35 (1950)
- Jeppesen JB, "Lactate metabolism in chronic liver disease", Scand J Clin Lab Invest, 73, pp.293~299 (2013)
- Sterling SA, "The effect of liver disease on lactate normalization in severe sepsis and septic shock : a cohort study", Clin Exp Emerg Med, 2, pp.197~202 (2015)
- Ha TS, "Lactate clearance and mortality in septic patients with hepatic dysfunction", Am J Emerg Med, 34, pp.1011~1015 (2016)
- Casserly B, "Lactate measurements in sepsis-induced tissue hypoperfusion : results from the Surviving Sepsis Campaign database", Crit Care Med, 43, pp.567~573 (2015)
- Møller S, "The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis", Liver Int, 38, pp.570~580 (2018)
- Fernández J, "Bacterial infections in cirrhosis : epidemiological changes with invasive procedures and norfloxacin prophylaxis", Hepatology, 35, pp.140~148 (2002)
- Caly WR, "A prospective study of bacterial infections in patients with cirrhosis", J Hepatol, 18, pp.353~358 (1993)
- Bunchorntavakul C, "Bacterial infections in cirrhosis : a critical review and practical guidance", World J Hepatol, 8, pp.307~321 (2016)