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Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients

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Abstract

Purpose

Hyperlactatemia may occur for a variety of reasons and is a predictor of poor clinical outcome. However, only limited data are available on the underlying causes of hyperlactatemia and the mortality rates associated with severe hyperlactatemia in critically ill patients. We therefore aimed to evaluate the etiology of severe hyperlactatemia (defined as a lactate level >10 mmol/L) in a large cohort of unselected ICU patients. We also aimed to evaluate the association between severe hyperlactatemia and lactate clearance with ICU mortality.

Methods

In this retrospective, observational study at an University hospital department with 11 ICUs during the study period between 1 April 2011 and 28 February 2013, we screened 14,040 ICU patients for severe hyperlactatemia (lactate >10 mmol/L).

Results

Overall mortality in the 14,040 ICU patients was 9.8 %. Of these, 400 patients had severe hyperlactatemia and ICU mortality in this group was 78.2 %. Hyperlactatemia was associated with death in the ICU [odds ratio 1.35 (95 % CI 1.23; 1.49; p < 0.001)]. The main etiology for severe hyperlactatemia was sepsis (34.0 %), followed by cardiogenic shock (19.3 %), and cardiopulmonary resuscitation (13.8 %). Patients developing severe hyperlactatemia >24 h of ICU treatment had a significantly higher ICU mortality (89.1 %, 155 of 174 patients) than patients developing severe hyperlactatemia ≤24 h of ICU treatment (69.9 %, 158 of 226 patients; p < 0.0001). Lactate clearance after 12 h showed a receiver-operating-characteristics area under the curve (ROC-AUC) value of 0.91 to predict ICU mortality (cut-off showing highest sensitivity and specifity was a 12 h lactate clearance of 32.8 %, Youden Index 0.72). In 268 patients having a 12-h lactate clearance <32.8 % ICU mortality was 96.6 %.

Conclusions

Severe hyperlactatemia (>10 mmol/L) is associated with extremely high ICU mortality especially when there is no marked lactate clearance within 12 h. In such situations, the benefit of continued ICU therapy should be evaluated.

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Authors and Affiliations

  1. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Sebastian A. Haas, Bernd Saugel & Martin Petzoldt

  2. Department of Intensive Care Medicine, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Theresa Lange, Valentin Fuhrmann, Maria Metschke & Stefan Kluge

Authors
  1. Sebastian A. Haas
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  2. Theresa Lange
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  3. Bernd Saugel
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  4. Martin Petzoldt
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  5. Valentin Fuhrmann
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  6. Maria Metschke
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  7. Stefan Kluge
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Corresponding author

Correspondence to Sebastian A. Haas.

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Conflicts of interest

MP is a member of the Medical Advisory Board of Radiometer Medical. All other authors declare no conflict of interest.

Source of funding

The complete study was funded internally by the Center of Anesthesiology and Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf.

Additional information

Take-home message: Severe hyperlactatemia (>10 mmol/l) was associated with very high mortality, especially in patients requiring extracorporeal organ support or when severe hyperlactatemia persisted for long periods. Patients’ chances of survival were substantially increased when severe hyperlactatemia was attributed to reversible pathophysiology such as cardiac surgery or seizure; therefore, the etiology of severe hyperlactatemia should be clearly defined in ICU patients if it is used to evaluate prognosis or as a basis for decisions about continuing ICU therapy.

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Haas, S.A., Lange, T., Saugel, B. et al. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med 42, 202–210 (2016). https://doi.org/10.1007/s00134-015-4127-0

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  • DOI: https://doi.org/10.1007/s00134-015-4127-0

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