Relative hyperlactatemia and hospital mortality in critically ill patients: A retrospective multi-centre study

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Abstract

Introduction: Higher lactate concentrations within the normal reference range (relative hyperlactatemia) are not considered clinically significant. We tested the hypothesis that relative hyperlactatemia is independently associated with an increased risk of hospital death. Methods: This observational study examined a prospectively obtained intensive care database of 7,155 consecutive critically ill patients admitted to the Intensive Care Units (ICUs) of four Australian university hospitals. We assessed the relationship between ICU admission lactate, maximal lactate and time-weighted lactate levels and hospital outcome in all patients and also in those patients whose lactate concentrations (admission n = 3,964, maximal n = 2,511, and timeweighted n = 4,584) were under 2 mmol.L-1 (i.e. relative hyperlactatemia). Results: We obtained 172,723 lactate measurements. Higher admission and time-weightedlactate concentration within the reference range was independently associated with increased hospital mortality (admission odds ratio (OR) 2.1, 95 confidence interval (CI) 1.3 to 3.5, P = 0.01; time-weighted OR 3.7, 95 CI 1.9 to 7.00, P <0.0001). This significant association was first detectable at lactate concentrations > 0.75 mmol.L-1. Furthermore, in patients whose lactate ever exceeded 2 mmol.L-1, higher time-weighted lactate remained strongly associated with higher hospital mortality (OR 4.8, 95 CI 1.8 to 12.4, P <0.001). Conclusions: In critically ill patients, relative hyperlactataemia is independently associated with increased hospital mortality. Blood lactate concentrations > 0.75 mmol.L-1 can be used by clinicians to identify patients at higher risk of death. The current reference range for lactate in the critically ill may need to be re-assessed.
Original languageEnglish
Pages (from-to)1 - 9
Number of pages9
JournalCritical Care
Volume14
Issue number1 (R25)
DOIs
Publication statusPublished - 2010

Cite this

@article{d3fda197205b490394813efddbae13b9,
title = "Relative hyperlactatemia and hospital mortality in critically ill patients: A retrospective multi-centre study",
abstract = "Introduction: Higher lactate concentrations within the normal reference range (relative hyperlactatemia) are not considered clinically significant. We tested the hypothesis that relative hyperlactatemia is independently associated with an increased risk of hospital death. Methods: This observational study examined a prospectively obtained intensive care database of 7,155 consecutive critically ill patients admitted to the Intensive Care Units (ICUs) of four Australian university hospitals. We assessed the relationship between ICU admission lactate, maximal lactate and time-weighted lactate levels and hospital outcome in all patients and also in those patients whose lactate concentrations (admission n = 3,964, maximal n = 2,511, and timeweighted n = 4,584) were under 2 mmol.L-1 (i.e. relative hyperlactatemia). Results: We obtained 172,723 lactate measurements. Higher admission and time-weightedlactate concentration within the reference range was independently associated with increased hospital mortality (admission odds ratio (OR) 2.1, 95 confidence interval (CI) 1.3 to 3.5, P = 0.01; time-weighted OR 3.7, 95 CI 1.9 to 7.00, P <0.0001). This significant association was first detectable at lactate concentrations > 0.75 mmol.L-1. Furthermore, in patients whose lactate ever exceeded 2 mmol.L-1, higher time-weighted lactate remained strongly associated with higher hospital mortality (OR 4.8, 95 CI 1.8 to 12.4, P <0.001). Conclusions: In critically ill patients, relative hyperlactataemia is independently associated with increased hospital mortality. Blood lactate concentrations > 0.75 mmol.L-1 can be used by clinicians to identify patients at higher risk of death. The current reference range for lactate in the critically ill may need to be re-assessed.",
author = "Nichol, {Alistair Dualta} and Moritoki Egi and Pettila, {Ville Yrjo Olavi} and Rinaldo Bellomo and French, {Craig J} and Hart, {Graeme Keith} and Davies, {Andrew Ross} and Edward Stachowski and Reade, {Michael C} and Bailey, {Michael John} and Cooper, {David James}",
year = "2010",
doi = "10.1186/cc8888",
language = "English",
volume = "14",
pages = "1 -- 9",
journal = "Critical Care",
issn = "1364-8535",
number = "1 (R25)",

}

TY - JOUR

T1 - Relative hyperlactatemia and hospital mortality in critically ill patients: A retrospective multi-centre study

AU - Nichol, Alistair Dualta

AU - Egi, Moritoki

AU - Pettila, Ville Yrjo Olavi

AU - Bellomo, Rinaldo

AU - French, Craig J

AU - Hart, Graeme Keith

AU - Davies, Andrew Ross

AU - Stachowski, Edward

AU - Reade, Michael C

AU - Bailey, Michael John

AU - Cooper, David James

PY - 2010

Y1 - 2010

N2 - Introduction: Higher lactate concentrations within the normal reference range (relative hyperlactatemia) are not considered clinically significant. We tested the hypothesis that relative hyperlactatemia is independently associated with an increased risk of hospital death. Methods: This observational study examined a prospectively obtained intensive care database of 7,155 consecutive critically ill patients admitted to the Intensive Care Units (ICUs) of four Australian university hospitals. We assessed the relationship between ICU admission lactate, maximal lactate and time-weighted lactate levels and hospital outcome in all patients and also in those patients whose lactate concentrations (admission n = 3,964, maximal n = 2,511, and timeweighted n = 4,584) were under 2 mmol.L-1 (i.e. relative hyperlactatemia). Results: We obtained 172,723 lactate measurements. Higher admission and time-weightedlactate concentration within the reference range was independently associated with increased hospital mortality (admission odds ratio (OR) 2.1, 95 confidence interval (CI) 1.3 to 3.5, P = 0.01; time-weighted OR 3.7, 95 CI 1.9 to 7.00, P <0.0001). This significant association was first detectable at lactate concentrations > 0.75 mmol.L-1. Furthermore, in patients whose lactate ever exceeded 2 mmol.L-1, higher time-weighted lactate remained strongly associated with higher hospital mortality (OR 4.8, 95 CI 1.8 to 12.4, P <0.001). Conclusions: In critically ill patients, relative hyperlactataemia is independently associated with increased hospital mortality. Blood lactate concentrations > 0.75 mmol.L-1 can be used by clinicians to identify patients at higher risk of death. The current reference range for lactate in the critically ill may need to be re-assessed.

AB - Introduction: Higher lactate concentrations within the normal reference range (relative hyperlactatemia) are not considered clinically significant. We tested the hypothesis that relative hyperlactatemia is independently associated with an increased risk of hospital death. Methods: This observational study examined a prospectively obtained intensive care database of 7,155 consecutive critically ill patients admitted to the Intensive Care Units (ICUs) of four Australian university hospitals. We assessed the relationship between ICU admission lactate, maximal lactate and time-weighted lactate levels and hospital outcome in all patients and also in those patients whose lactate concentrations (admission n = 3,964, maximal n = 2,511, and timeweighted n = 4,584) were under 2 mmol.L-1 (i.e. relative hyperlactatemia). Results: We obtained 172,723 lactate measurements. Higher admission and time-weightedlactate concentration within the reference range was independently associated with increased hospital mortality (admission odds ratio (OR) 2.1, 95 confidence interval (CI) 1.3 to 3.5, P = 0.01; time-weighted OR 3.7, 95 CI 1.9 to 7.00, P <0.0001). This significant association was first detectable at lactate concentrations > 0.75 mmol.L-1. Furthermore, in patients whose lactate ever exceeded 2 mmol.L-1, higher time-weighted lactate remained strongly associated with higher hospital mortality (OR 4.8, 95 CI 1.8 to 12.4, P <0.001). Conclusions: In critically ill patients, relative hyperlactataemia is independently associated with increased hospital mortality. Blood lactate concentrations > 0.75 mmol.L-1 can be used by clinicians to identify patients at higher risk of death. The current reference range for lactate in the critically ill may need to be re-assessed.

UR - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875540/pdf/cc8888.pdf

U2 - 10.1186/cc8888

DO - 10.1186/cc8888

M3 - Article

VL - 14

SP - 1

EP - 9

JO - Critical Care

JF - Critical Care

SN - 1364-8535

IS - 1 (R25)

ER -