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. 2020 Oct;8(19):1240.
doi: 10.21037/atm-20-6317.

Association between serum lactate levels and enteral feeding intolerance in septic patients treated with vasopressors: a retrospective cohort study

Zhi Mao  1 , Guoxiong Liu  2 , Qing Yu  3 , Shuang Qi  1 , Yunchi Lou  4 , Chao Liu  5 , Qinglin Li  1 , Chao Xue  1 , Hongjun Kang  1 , Quan Hong  5 , Feihu Zhou  1   5   6
Affiliations

Association between serum lactate levels and enteral feeding intolerance in septic patients treated with vasopressors: a retrospective cohort study

Zhi Mao et al. Ann Transl Med. 2020 Oct.

Abstract

Background: To assess the association between serum lactate levels and intolerance to enteral nutrition (EN) in septic patients treated with vasopressors.

Methods: This retrospective study was conducted between January 1, 2015 and May 1, 2018 in an intensive care unit (ICU). Patients with sepsis who were given EN and treated with vasopressors were included. EmpowerStats software and R (version 3.3.2) was used to examine the association between serum lactate levels and intolerance to EN.

Results: Among the 132 septic patients (age, 60.6±18.1 years) enrolled, 35 (26.5%) patients suffered intolerance to EN. Multiple logistic regression analysis demonstrated that an elevated lactate level was an independent risk factor for EN intolerance [odds ratio (OR): 2.7; 95% confidence interval (CI): 1.6-4.4; P<0.001]. The area under the receiver operating characteristic (ROC) curve for serum lactate levels was 0.764 (95% CI: 0.664-0.864). Stratified analysis suggested that age was the most prominent interactive factor for serum lactate levels in EN intolerance. Serum lactate levels were closely correlated to EN intolerance in elderly patients (age ≥65 years) (OR: 9.5; 95% CI: 2.1-42.4; P=0.0261 for interaction), while no such association was identified in younger patients (age <65 years; OR: 1.7; 95% CI: 1.0-2.9; P=0.052).

Conclusions: Serum lactate levels were associated with an increased risk of EN intolerance in patients with sepsis, especially in elderly individuals. An elevated serum lactate level may be an early predictor of EN intolerance in elderly septic patients treated with vasopressors. However, further studies are called for to verify these findings.

Keywords: Serum lactate level; enteral nutrition (EN); intolerance; sepsis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-6317). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of participants including. EN, enteral nutrition.
Figure 2
Figure 2
Smooth curve fitting of serum lactate levels and tolerance to enteral nutrition in patients with sepsis. Adjustment variables: age, sex, MV, and AGI. MV, mechanical ventilation; AGI, acute gastrointestinal injury.
Figure 3
Figure 3
Receiver operating characteristic curve of the relationship between serum lactate levels and tolerance to enteral nutrition in patients with sepsis. AUC, area under the curve.
Figure 4
Figure 4
Subgroup smooth curve fitting of serum lactate level and EN tolerance in septic patients stratified by age. Adjustment variables: age, gender, MV, and AGI. EN, enteral nutrition; MV, mechanical ventilation; AGI, acute gastrointestinal injury.
Figure 5
Figure 5
Receiver operating characteristic curve of the relationship between serum lactate level and tolerance to enteral nutrition in septic patients aged ≥65. AUC, area under the curve.
See this image and copyright information in PMC

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