Department of General and Visceral Surgery, Medical Center-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
Center for Complementary Medicine, Department of Internal Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
BMC Surg. 2022 Aug 11;22(1):312. doi: 10.1186/s12893-022-01729-2.
Etiology of hyperlactatemia in ICU patients is heterogeneous-septic, cardiogenic or hemorrhagic shock seem to be predominant reasons. Multiple studies show hyperlactatemia as an independent predictor for ICU mortality. Only limited data exists about the etiology of hyperlactatemia and lactate clearance and their influence on mortality. The goal of this single-center retrospective study, was to evaluate the effect of severe hyperlactatemia and reduced lactate clearance rate on the outcome of unselected ICU surgical patients.
Overall, 239 surgical patients with severe hyperlactatemia (> 10 mmol/L) who were treated in the surgical ICU at the University Medical Center Freiburg between June 2011 and August 2017, were included in this study. The cause of the hyperlactatemia as well as the postoperative course and the patient morbidity and mortality were retrospectively analyzed. Lactate clearance was calculated by comparing lactate level 12 h after first measurement of > 10 mmol/L.
The overall mortality rate in our cohort was 82.4%. Severe hyperlactatemia was associated with death in the ICU (p < 0.001). The main etiologic factor was sepsis (51.9%), followed by mesenteric ischemia (15.1%), hemorrhagic shock (13.8%) and liver failure (9.6%). Higher lactate levels at ICU admission were associated with increased mortality (p < 0.001). Lactate clearance after 12 h was found to predict ICU mortality (ANOVA p < 0.001) with an overall clearance of under 50% within 12 h. The median percentage of clearance was 60.3% within 12 h for the survivor and 29.1% for the non-survivor group (p < 0.001).
Lactate levels appropriately reflect disease severity and are associated with short-term mortality in critically ill patients. The main etiologic factor for surgical patients is sepsis. When elevated lactate levels persist more than 12 h, survival chances are low and the benefit of continued maximum therapy should be evaluated.
ICU 患者高乳酸血症的病因具有异质性，似乎以脓毒症、心源性或出血性休克为主。多项研究表明高乳酸血症是 ICU 死亡率的独立预测因素。关于高乳酸血症的病因、乳酸清除率及其对死亡率的影响，仅有有限的数据。本单中心回顾性研究的目的是评估严重高乳酸血症和乳酸清除率降低对未选择 ICU 外科患者结局的影响。
本研究共纳入 2011 年 6 月至 2017 年 8 月期间在弗赖堡大学医学中心外科 ICU 接受治疗的 239 例严重高乳酸血症（>10mmol/L）的外科患者。回顾性分析高乳酸血症的病因、术后过程以及患者的发病率和死亡率。通过比较首次测量>10mmol/L 后 12 小时的乳酸水平来计算乳酸清除率。
本队列的总死亡率为 82.4%。严重高乳酸血症与 ICU 死亡相关（p<0.001）。主要病因是脓毒症（51.9%），其次是肠系膜缺血（15.1%）、出血性休克（13.8%）和肝功能衰竭（9.6%）。入住 ICU 时较高的乳酸水平与死亡率增加相关（p<0.001）。12 小时后乳酸清除率可预测 ICU 死亡率（ANOVA p<0.001），12 小时内清除率低于 50%。存活组的中位清除率为 60.3%，而非存活组为 29.1%（p<0.001）。
乳酸水平能适当反映疾病严重程度，与危重症患者的短期死亡率相关。外科患者的主要病因是脓毒症。如果升高的乳酸水平持续超过 12 小时，存活机会较低，应评估继续最大治疗的获益。
