Vieira Inês H, Petrova Maja, Moura José P
Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Center, Coimbra, PRT.
Internal Medicine, Coimbra Hospital and University Center, Coimbra, PRT.
Cureus. 2022 May 20;14(5):e25163. doi: 10.7759/cureus.25163. eCollection 2022 May.
Background Hyperlactatemia is defined by a lactate concentration of >2 mmol/L, and a lactate concentration of above >4 mmol/L is commonly used to define severe hyperlactatemia. It is a common disorder in critically ill patients and is associated with adverse prognosis. Diabetes mellitus(DM) can also be associated with increased lactate levels at baseline. In this study, we aimed to document the development of severe hyperlactatemia in acute situations among patients with and without DM, to analyze potential contributors to lactate elevation and their impact on mortality, and to analyze whether lactate concentrations of >4 mmol/L have equal prognostic significance in patients with and without DM. Methodology A retrospective, cross-sectional study was performed among patients admitted to our internal medicine wards in the context of acute disease with lactate concentrations of ≥2 mmol/L. Data were collected regarding age, sex, highest lactate concentrations, cause of hyperlactatemia, DM, and mortality. Statistical analysis was performed using SPSS version 23. Results In total, 151 patients with lactate levels of ≥2 mmol/L were analyzed. The mean age of the patients was 78.2 ± 14.9 years, and 55% of the patients were female. Overall, 55.6% of the patients had DM, as well as higher lactatemia of 6.3 ± 3.4 mmol/L (vs 5.1 ± 3.2 in non-DM patients, p = 0.003), with the majority reaching values of >4 mmol/L (vs 34.8% in non-DM patients). When potential contributors to the development of severe hyperlactatemia (lactate >4 mmol/L) were analyzed in DM patients, metformin consumption concomitantly with factors potentiating its accumulation, sepsis/septic shock, ischemia, and neoplasia were the most frequently identified contributors. In non-DM patients, the three former factors were also the most frequently reported. The 30-day mortality rate was 25.82%, with deceased patients also displaying a higher lactatemia of 6.5 ± 3.2 mmol/L (vs. 5.5 ± 3.3 mmol/L in patients who survived) (p = 0.037). In multivariate analysis, lactate values of >4 mmol/L were an independent predictor of mortality in the entire sample and in the subgroup without DM, but not in DM patients. Conclusions In our sample, patients with DM had higher lactate levels than non-DM patients. Our analysis raises the possibility that the same lactate values may not have equal capacity to assess prognosis in acute situations in patients with and without DM. Large-scale studies are needed to optimize cut-off points for lactatemia in patients with high baseline values, such as DM patients.
高乳酸血症定义为乳酸浓度>2 mmol/L，乳酸浓度>4 mmol/L通常用于定义严重高乳酸血症。它是危重症患者中的常见病症，与不良预后相关。糖尿病（DM）在基线时也可能与乳酸水平升高有关。在本研究中，我们旨在记录急性情况下有或无DM患者中严重高乳酸血症的发生情况，分析乳酸升高的潜在因素及其对死亡率的影响，并分析乳酸浓度>4 mmol/L在有或无DM患者中是否具有相同的预后意义。
对入住我院内科病房、乳酸浓度≥2 mmol/L的急性病患者进行了一项回顾性横断面研究。收集了有关年龄、性别、最高乳酸浓度、高乳酸血症病因、DM和死亡率的数据。使用SPSS 23版进行统计分析。
共分析了151例乳酸水平≥2 mmol/L的患者。患者的平均年龄为78.2±14.9岁，55%为女性。总体而言，55.6%的患者患有DM，且乳酸血症水平更高，为6.3±3.4 mmol/L（非DM患者为5.1±3.2 mmol/L，p = 0.003），大多数患者达到>4 mmol/L的值（非DM患者为34.8%）。在分析DM患者中严重高乳酸血症（乳酸>4 mmol/L）发生的潜在因素时，二甲双胍的使用以及使其蓄积的因素、脓毒症/脓毒性休克、缺血和肿瘤是最常确定的因素。在非DM患者中，前三个因素也是最常报告的因素。30天死亡率为25.82%，死亡患者的乳酸血症水平也更高，为6.5±3.2 mmol/L（存活患者为5.5±3.3 mmol/L）（p = 0.037）。在多变量分析中，乳酸值>4 mmol/L是整个样本和无DM亚组中死亡率的独立预测因素，但在DM患者中不是。
在我们的样本中，DM患者的乳酸水平高于非DM患者。我们的分析提出了一种可能性，即在急性情况下，相同的乳酸值在有或无DM患者中评估预后的能力可能不相等。需要进行大规模研究以优化基线值较高的患者（如DM患者）乳酸血症的临界值。
