Hyperlactatemia and altered lactate kinetics are associated with excess mortality in sepsis : A multicenter retrospective observational study

Abstract

Severe hyperlactatemia (>10mmol/L) or impaired lactate metabolism are known to correlate with increased mortality. The maximum lactate concentration on day 1 of 10,724 septic patients from the eICU Collaborative Research Database was analyzed and patients were divided into three groups based on maximum lactate in the first 24 h (<5mmol/l; ≥5mmol/l & <10mmol/l; ≥10mmol/l). In addition, delta lactate was calculated using the following formula: (maximum lactate day 1 minus maximum lactate day 2) divided by maximum lactate day 1. A multilevel regression analysis was performed, with hospital mortality serving as the primary study end point. Significant differences in hospital mortality were found in patients with hyperlactatemia (lactate ≥10mmol/l: 79%, ≥5mmol/l & <10mmol/l: 43%, <5mmol/l, 13%; p<0.001). The sensitivity of severe hyperlactatemia (≥10mmol/l) for hospital mortality was 17%, the specificity was 99%. In patients with negative delta lactate in the first 24 h, hospital mortality was excessive (92%). In conclusion, mortality in patients with severe hyperlactatemia is very high, especially if it persists for more than 24 h. Severe hyperlactatemia, together with clinical parameters, could therefore provide a basis for setting treatment limits.

Keywords: Biomarkers; Clinical decision-making; Critical care outcomes; Prognosis; Risk assessment.

Fig. 1

Of a total of 10,724 septic patients from the eICU Collaborative Research Database, 9208 individuals (85.9%) had low (serum lactate < 5 mmol/l), 1056 patients (9.8%) moderate (serum lactate ≥ 5 and < 10 mmol/l) and 460 participants (4.3%) severe hyperlactatemia (≥ 10 mmol/l). Of all patients with severe hyperlactatemia, 98 (21%) survived and 362 (79%) died. Patients from the severe hyperlactatemia group with a positive delta lactate at 24 h had significantly lower in-hospital mortality (53%) than patients without a positive 24‑h delta lactate (92%, p < 0.001)