Department of Nephrology, Ghent University Hospital, Ghent, Belgium.
Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
Blood Purif. 2022;51(7):577-583. doi: 10.1159/000518918. Epub 2021 Sep 15.
Hyperlactatemia is a regular condition in the intensive care unit, which is often associated with adverse outcomes. Control of the triggering condition is the most effective treatment of hyperlactatemia, but since this is mostly not readily possible, extracorporeal renal replacement therapy (RRT) is often tried as a last resort. The present study aims to evaluate the factors that may contribute to the decision whether to start RRT or not and the potential impact of the start of RRT on the outcome in patients with severe lactic acidosis (SLA) (lactate ≥5 mmol/L).
We conducted a retrospective single-center cohort analysis over a 3-year period including all patients with a lactate level ≥5 mmol/L. Patients were considered as treated with RRT because of SLA if RRT was started within 24 h after reaching a lactate level ≥5 mmol/L.
Overall, 90-day mortality in patients with SLA was 34.5%. Of the 1,203 patients who matched inclusion/exclusion criteria, 11% (n = 133) were dialyzed within 24 h. The propensity to receive RRT was related to the lactate level and to the SOFA renal and cardio score. The most frequently used modality was continuous RRT. Patients who were started on RRT versus those who did not have 2.3 higher odds of mortality, even after adjustment for the propensity to start RRT.
Our analysis confirms the high mortality rate of patients with SLA. It adds that odds for mortality is even higher in patients who were started on RRT versus not. We suggest keeping an open mind to the factors that may influence the decision to start dialysis and bear in mind that without being a bridge to correction of the underlying condition, dialysis is unlikely to affect the outcome.
高乳酸血症是重症监护病房的常见病症，常与不良预后相关。控制触发因素是治疗高乳酸血症最有效的方法，但由于大多数情况下无法做到这一点，因此常尝试体外肾替代治疗（RRT）作为最后的手段。本研究旨在评估可能影响是否开始 RRT 的决策的因素，以及开始 RRT 对严重乳酸酸中毒（SLA）（乳酸≥5mmol/L）患者结局的潜在影响。
我们进行了一项为期 3 年的回顾性单中心队列分析，纳入了所有乳酸水平≥5mmol/L 的患者。如果在达到乳酸水平≥5mmol/L 后 24 小时内开始 RRT，则认为患者因 SLA 而接受 RRT 治疗。
总体而言，SLA 患者的 90 天死亡率为 34.5%。在符合纳入/排除标准的 1203 名患者中，有 11%（n=133）在 24 小时内接受透析。接受 RRT 的倾向与乳酸水平和 SOFA 肾和心评分有关。最常使用的模式是连续 RRT。与未接受 RRT 的患者相比，开始接受 RRT 的患者的死亡率高出 2.3 倍，即使在调整了开始 RRT 的倾向后也是如此。
我们的分析证实了 SLA 患者的高死亡率。此外，与未接受 RRT 的患者相比，开始接受 RRT 的患者的死亡率更高。我们建议对可能影响开始透析决策的因素保持开放的心态，并牢记一点，即如果没有作为纠正基础疾病的桥梁，透析不太可能影响结局。
