Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: A microSOAP post hoc analysis

Vellinga, N. A.R., Boerma, E. C., Koopmans, M., Donati, A., Dubin, A., Shapiro, N. I., Pearse, R. M., van der Voort, P. H.J., Dondorp, A. M., Bafi, Tony, Fries, M., Akarsu-Ayazoglu, Tulin, Pranskunas, A., Hollenberg, Steven, Balestra, Gianmarco, van Iterson, M., Sadaka, Farid, Minto, G., Aypar, U., Hurtado, F. J., Martinelli, G., Payen, D., van Haren, Frank, Holley, A., Gomez, H., Mehta, R., Rodriguez, A. H., Ruiz, C., Canales, H. S., Duranteau, J., Spronk, P. E., Jhanji, S., Hubble, Sheena, Chierego, Marialuisa, Jung, C., Martin, Daniel, Sorbara, C., Bakker, J., Ince, Can, Boerma, E. C., Koopmans, M., Vellinga, N. A.R., van Iterson, M., van der Voort, P. H.J., Bakker, J., van Bommel, J., Spronk, P. E., Ruiz, C., Hernandez, G., Machado, F. R., Bafi, A. T., Dubin, A., Kanoore Edul, V. S., Canales, H. S., Hurtado, F. J., Lacuesta, G., Baz, M., Hollenberg, S. M., Patel, U., Shapiro, N. I., Gomez, H., Pinsky, M., Sadaka, F. G., Krause, K., Mehta, R., Jung, C., Fries, M., Pearse, R. M., Smith, A., Martin, D. S., Meale, P., Jhanji, S., Minto, G., Martinelli, G., Lombrano, M., Hubble, S. M.A., Thorn, C., Rodriguez, A. H., Martin-Loeches, I., van Haren, F. M.P., Pranskunas, A., Pilvinis, V., Donati, A., Sorbara, C., Forti, A., Comin, A., Chierego, M. L., Pellis, T., Holley, A., Paratz, J., Duranteau, J., Harrois, A., Payen, D., Damoisel, C., Balestra, G. M., Bucher, E., Pattnaik, R., Dondorp, A. M., Herdman, M. T., Aypar, U., Ayhan, B. and Ayazoglu-Akarsu, T. (2017) Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: A microSOAP post hoc analysis. Critical Care, 21 1: . doi:10.1186/s13054-017-1842-7


Author Vellinga, N. A.R.
Boerma, E. C.
Koopmans, M.
Donati, A.
Dubin, A.
Shapiro, N. I.
Pearse, R. M.
van der Voort, P. H.J.
Dondorp, A. M.
Bafi, Tony
Fries, M.
Akarsu-Ayazoglu, Tulin
Pranskunas, A.
Hollenberg, Steven
Balestra, Gianmarco
van Iterson, M.
Sadaka, Farid
Minto, G.
Aypar, U.
Hurtado, F. J.
Martinelli, G.
Payen, D.
van Haren, Frank
Holley, A.
Gomez, H.
Mehta, R.
Rodriguez, A. H.
Ruiz, C.
Canales, H. S.
Duranteau, J.
Spronk, P. E.
Jhanji, S.
Hubble, Sheena
Chierego, Marialuisa
Jung, C.
Martin, Daniel
Sorbara, C.
Bakker, J.
Ince, Can
Boerma, E. C.
Koopmans, M.
Vellinga, N. A.R.
van Iterson, M.
van der Voort, P. H.J.
Bakker, J.
van Bommel, J.
Spronk, P. E.
Ruiz, C.
Hernandez, G.
Machado, F. R.
Bafi, A. T.
Dubin, A.
Kanoore Edul, V. S.
Canales, H. S.
Hurtado, F. J.
Lacuesta, G.
Baz, M.
Hollenberg, S. M.
Patel, U.
Shapiro, N. I.
Gomez, H.
Pinsky, M.
Sadaka, F. G.
Krause, K.
Mehta, R.
Jung, C.
Fries, M.
Pearse, R. M.
Smith, A.
Martin, D. S.
Meale, P.
Jhanji, S.
Minto, G.
Martinelli, G.
Lombrano, M.
Hubble, S. M.A.
Thorn, C.
Rodriguez, A. H.
Martin-Loeches, I.
van Haren, F. M.P.
Pranskunas, A.
Pilvinis, V.
Donati, A.
Sorbara, C.
Forti, A.
Comin, A.
Chierego, M. L.
Pellis, T.
Holley, A.
Paratz, J.
Duranteau, J.
Harrois, A.
Payen, D.
Damoisel, C.
Balestra, G. M.
Bucher, E.
Pattnaik, R.
Dondorp, A. M.
Herdman, M. T.
Aypar, U.
Ayhan, B.
Ayazoglu-Akarsu, T.
Title Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: A microSOAP post hoc analysis
Journal name Critical Care   Check publisher's open access policy
ISSN 1466-609X
1364-8535
Publication date 2017-10-18
Year available 2017
Sub-type Article (original research)
DOI 10.1186/s13054-017-1842-7
Open Access Status DOI
Volume 21
Issue 1
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Subject 2706 Critical Care and Intensive Care Medicine
Abstract 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.
Keyword Intensive care
Lactate
Microcirculation
Prevalence
SDF imaging
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Health and Rehabilitation Sciences Publications
 
Versions
Version Filter Type
Citation counts: Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Fri, 03 Nov 2017, 09:09:52 EST