Department of Neurosciences, Section of Clinical Biochemistry, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.
Clin Chem Lab Med. 2021 Dec 2;60(3):332-337. doi: 10.1515/cclm-2021-1115. Print 2022 Feb 23.
Coronavirus disease 2019 (COVID-19) is an infectious respiratory condition sustained by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which manifests prevalently as mild to moderate respiratory tract infection. Nevertheless, in a number of cases the clinical course may deteriorate, with onset of end organ injury, systemic dysfunction, thrombosis and ischemia. Given the clinical picture, baseline assessment and serial monitoring of blood lactate concentration may be conceivably useful in COVID-19. We hence performed a systematic literature review to explore the possible association between increased blood lactate levels, disease severity and mortality in COVID-19 patients, including comparison of lactate values between COVID-19 and non-COVID-19 patients. We carried out an electronic search in Medline and Scopus, using the keywords "COVID-19" OR "SARS-CoV-2" AND "lactate" OR "lactic acid" OR "hyperlactatemia", between 2019 and present time (i.e. October 10, 2021), which allowed to identify 19 studies, totalling 6,459 patients. Overall, we found that COVID-19 patients with worse outcome tend to display higher lactate values than those with better outcome, although most COVID-19 patients in the studies included in our analysis did not have sustained baseline hyperlactatemia. Substantially elevated lactate values were neither consistently present in all COVID-19 patients who developed unfavourable clinical outcomes. These findings suggest that blood lactate monitoring upon admission and throughout hospitalization may be useful for early identification of higher risk of unfavourable COVID-19 illness progression, though therapeutic decisions based on using conventional hyperlactatemia cut-off values (i.e., 2.0 mmol/L) upon first evaluation may be inappropriate in patients with SARS-CoV-2 infection.
2019 年冠状病毒病（COVID-19）是一种由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）引起的传染性呼吸道疾病，主要表现为轻度至中度呼吸道感染。然而，在许多情况下，临床病程可能会恶化，出现终末器官损伤、全身功能障碍、血栓形成和缺血。鉴于临床表现，基线评估和连续监测血乳酸浓度可能在 COVID-19 中具有一定的作用。因此，我们进行了系统的文献回顾，以探讨 COVID-19 患者中血乳酸水平升高、疾病严重程度和死亡率之间的可能关联，包括 COVID-19 患者与非 COVID-19 患者之间的乳酸值比较。我们在 Medline 和 Scopus 上使用关键字“COVID-19”或“SARS-CoV-2”和“乳酸”或“乳酸酸中毒”或“高乳酸血症”进行了电子搜索，搜索时间范围为 2019 年至现在（即 2021 年 10 月 10 日），共检索到 19 项研究，总计 6459 例患者。总体而言，我们发现预后较差的 COVID-19 患者的乳酸值往往高于预后较好的患者，尽管我们分析中纳入的研究中的大多数 COVID-19 患者没有持续的基线高乳酸血症。在所有发生不良临床结局的 COVID-19 患者中，乳酸值显著升高也并非普遍存在。这些发现表明，入院时和住院期间监测血乳酸值可能有助于早期识别 COVID-19 疾病进展的高风险，但基于首次评估时使用常规高乳酸血症截断值（即 2.0mmol/L）做出的治疗决策可能不适用于 SARS-CoV-2 感染患者。
