Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis.
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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, microSOAP study group
Аннотация
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.