Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Jan 6;129(1):11-6.
doi: 10.1590/s1516-31802011000100003.

Comparison of lactate values obtained from different sites and their clinical significance in patients with severe sepsis

Ana Paula Metran Nascente  1 , Murillo Assunção, Carla Janaina Guedes, Flávio Geraldo Rezende Freitas, Bruno Franco Mazza, Miriam Jackiu, Flávia Ribeiro Machado
Affiliations

Comparison of lactate values obtained from different sites and their clinical significance in patients with severe sepsis

Ana Paula Metran Nascente et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context and objective: The ideal site for lactate collection has not been clearly established. This study aimed to evaluate associations between lactate levels in arterial blood (Lart), peripheral venous blood (Lper) and central venous blood (Lcen) in patients with severe sepsis or septic shock.

Design and setting: Cross-sectional analytical study in an tertiary university hospital.

Method: Samples from patients with a central venous catheter and from healthy volunteers (control group) were collected. Blood was drawn simultaneously for measurements of Lart, Lper and Lcen, and the first sample was collected less than 24 hours after the onset of organ dysfunction. The results were analyzed using Pearson correlation, Bland-Altman and McNemar tests.

Results: A total of 238 samples were collected from 32 patients. The correlation results were r = 0.79 (P < 0.0001) for Lart/Lper and r = 0.84 (P < 0.0001) for Lart/Lcen. Bland-Altman showed large limits of agreement: -3.2 ± 4.9 (-12.8 to 6.4) and -0.8 ± 5.9 (-12.5 to 10.8), for Lper and Lcen respectively. In the control group, there was greater correlation (r = 0.9009, P = 0.0004) and agreement: -0.7 ± 1.2 (-3.1 to 1.7). Regarding clinical intervention, there was good agreement between Lart/Lcen (96.3%; three disagreements), with worst results for Lart/Lper (87.0%) with 10 cases of disagreement (P = 0.04). In eight patients (80.0%) Lper was higher than Lart.

Conclusion: Lcen, and not Lper, can replace Lart with good correlation and clinical agreement. Lper tends to overestimate Lart, thus leading to unnecessary therapeutic interventions.

CONTEXTO E OBJETIVO:: O sítio ideal de coleta do lactato não está claramente estabelecido. Este estudo objetivou avaliar a associação dos valores de lactato do sangue arterial (Lart), venoso periférico (Lper) e venoso central (Lcen) em pacientes com sepse grave ou choque séptico.

TIPO DE ESTUDO E LOCAL:: Estudo transversal analítico em hospital universitário terciário.

MÉTODOS:: Amostras de pacientes com cateter venoso central e voluntários sadios (grupo controle) foram coletadas. O sangue foi obtido de forma simultânea para medida do Lart, Lper and Lcen, sendo a primeira amostra coletada no máximo 24 horas após o início da disfunção orgânica. Resultados foram analisados usando a correlação de Pearson, os testes de Bland-Altman e McNemar.

RESULTADOS:: Um total de 238 amostras foi coletado em 32 pacientes. Resultados da correlação: r = 0.79 (P < 0,0001) para Lart/Lper e r = 0.84 (P < 0,0001) para Lart/Lcen. Bland-Altman mostrou largos limites de concordância, -3.2 ± 4.9 (-12.8 to 6.4) and -0.8 ± 5.9 (-12.5 to 10.8), para Lper e Lcen, respectivamente. No grupo controle, houve uma maior correlação (r = 0.9009, P = 0,0004) e concordância: -0.7 ± 1.2 (-3.1 to 1.7). No que se refere à intervenção clínica, houve boa concordância Lart/Lcen (96.3%, três não concordantes), com resultados piores encontrados para Lart/Lper (87.0%) com 10 casos não concordantes (P = 0,04). Em oito pacientes (80.0%) Lper foi mais elevado que Lart.

CONCLUSÃO:: Lcen, e não Lper, pode substituir Lart com boa correlação e concordância clínica. Lper tende a superestimar Lart, assim levando a intervenções terapêuticas desnecessárias.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None

Figures

Figure 1:
Figure 1:
Results from the study group.
Figure 2.
Figure 2.
Results from the control group.
See this image and copyright information in PMC

Comment in

  • Determination of lactate value.
    Wiwanitkit V. Wiwanitkit V. Sao Paulo Med J. 2012;130(2):130; author reply 130-1. doi: 10.1590/s1516-31802012000200011. Sao Paulo Med J. 2012. PMID: 22481761 Free PMC article. No abstract available.

References

    1. Rivers E, Nguyen B, Havstad S, et al. . Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-77. - PubMed
    1. Ciarka A, De Backer D, Vincent JL. Lactic acidosis in the critically ill. Acta Clin Belg. 2000;55(6):295-9. - PubMed
    1. De Backer D. Lactic acidosis. Minerva Anestesiol. 2003;69(4):281-4. - PubMed
    1. Gutierrez G, Wulf ME. Lactic acidosis in sepsis: another commentary. Crit Care Med. 2005;33(10):2420-2. - PubMed
    1. Valenza F, Aletti G, Fossali T, et al. . Lactate as a marker of energy failure in critically ill patients: hypothesis. Crit Care. 2005;9(6):588-93. - PMC - PubMed