Mildly Elevated Lactate Levels Are Associated With Microcirculatory Flow Abnormalities And Increased Mortality: A Microsoap Post Hoc Analysis
Tarih
2017Yazar
Vellinga, Namkje A. R.
Boerma, E. Christiaan
Koopmans, Matty
Donati, Abele
Dubin, Arnaldo
Shapiro, Nathan I.
Pearse, Rupert M.
van der Voort, Peter H. J.
Dondorp, Arjen M.
Bafi, Tony
Fries, Michael
Akarsu-Ayazoglu, Tulin
Pranskunas, Andrius
Hollenberg, Steven
Balestra, Gianmarco
van Iterson, Mat
Sadaka, Farid
Minto, Gary
Aypar, Ulku
Hurtado, F. Javier
Martinelli, Giampaolo
Payen, Didier
van Haren, Frank
Holley, Anthony
Gomez, Hernando
Mehta, Ravindra L.
Rodriguez, Alejandro H.
Ruiz, Carolina
Canales, Héctor S.
Duranteau, Jacques
Spronk, Peter E.
Jhanji, Shaman
Hubble, Sheena
Chierego, Marialuisa
Jung, Christian
Martin, Daniel
Sorbara, Carlo
Bakker, Jan
Ince, Can
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Background Mildly elevated lactate levels (i.e., 1–2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to evaluate the association between relative hyperlactatemia, microcirculatory flow, and outcome. Methods This study was a predefined subanalysis of a multicenter international point prevalence study on microcirculatory flow abnormalities, the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Microcirculatory flow abnormalities were assessed with sidestream dark-field imaging. Abnormal microcirculatory flow was defined as a microvascular flow index (MFI) < 2.6. MFI is a semiquantitative score ranging from 0 (no flow) to 3 (continuous flow). Associations between microcirculatory flow abnormalities, single-spot lactate measurements, and outcome were analyzed. Results In 338 of 501 patients, lactate levels were available. For this substudy, all 257 patients with lactate levels ≤ 2 mmol/L (median [IQR] 1.04 [0.80–1.40] mmol/L) were included. Crude ICU mortality increased with each lactate quartile. In a multivariable analysis, a lactate level > 1.5 mmol/L was independently associated with a MFI < 2.6 (OR 2.5, 95% CI 1.1–5.7, P = 0.027). Conclusions In a heterogeneous ICU population, a single-spot mildly elevated lactate level (even within the reference range) was independently associated with increased mortality and microvascular flow abnormalities. In vivo microscopy of the microcirculation may be helpful in discriminating between flow- and non-flow-related causes of mildly elevated lactate levels. Trial registration ClinicalTrials.gov, NCT01179243. Registered on August 3, 2010. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1842-7) contains supplementary material, which is available to authorized users.
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https://doi.org/10.1186/s13054-017-1842-7https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5646128/
http://hdl.handle.net/11655/15186