Ekart Robert, Kobal Barbara, Korošec Tea, Jakopin Eva, Svenšek Franc, Piko Nejc, Bevc Sebastjan, Hojs Radovan
Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Ljubljanska 5, Maribor, 2000, Slovenia.
Medical Faculty, University of Maribor, Taborska 8, Maribor, 2000, Slovenia.
BMC Nephrol. 2025 Apr 30;26(1):217. doi: 10.1186/s12882-025-04149-5.
Hyperlactatemia is common in intensive care unit (ICU) patients. The aim of our retrospective observational study was to analyse the impact of serum lactate on admission on mortality in patients with acute kidney injury (AKI) treated with renal replacement therapy (RRT).
During the study period of 4 years, 2939 patients were admitted to the ICU, 503 patients were diagnosed with AKI and 209 of them required RRT. After excluding patients on chronic dialysis and with known malignant disease, we retrospectively analysed 154 patients. Hyperlactatemia was defined as a serum lactate concentration above 4 mmol/L on admission to the ICU.
The mean age of patients was 62.8 years, and 69.5% were men. The mean Charlson Comorbidity Index (CCI) on admission to the ICU was 3.7 and fifty-six (36.4%) patients had acute hyperlactatemia. All included patients had AKI stage 3 and were treated with RRT, 125 (81.2%) with continuous RRT and 29 (18.8%) with intermittent hemodialysis. The mean length of stay in the ICU was 15.7 ± 13 days and 118 (76.6%) patients died during the 60-day observation period. A Kaplan-Meier survival analysis showed that the survival rate was statistically significantly lower in the group of patients with hyperlactatemia (log-rank; p = 0.032). The univariate Cox regression analysis showed that serum lactate on admission to the ICU significantly predict 60-day survival (HR 1.075; 95%CI 1.015-1.140; p = 0.014). In the multivariate Cox regression analysis, which included age, gender, diabetes, hypertension, chronic kidney disease, estimated glomerular filtration rate, serum lactate, CCI and C-reactive protein, only age (HR 1.031; 95%CI 1.007-1.056; p = 0.011) and serum lactate (HR 1.067; 95%CI 1.004-1.134; p = 0.035) were independent predictors of mortality.
Our study underscores the independent association between hyperlactatemia of more than 4 mmol/L on admission to the ICU and increased 60-day mortality in patients with AKI treated with RRT. These findings, which have significant implications for the management and prognosis of critically ill patients with AKI, provide a new understanding of the role of serum lactate in patient outcomes.
Name of the registry: ClinicalTrials.gov; Trial registration number: NCT06565403; Date of registration, followed by the words 'Retrospectively registered': August, 19,2024; URL of trial registry record: https://clinicaltrials.gov/study/NCT06565403.
高乳酸血症在重症监护病房（ICU）患者中很常见。我们这项回顾性观察研究的目的是分析急性肾损伤（AKI）患者接受肾脏替代治疗（RRT）时，入院时血清乳酸水平对死亡率的影响。
在为期4年的研究期间，2939例患者入住ICU，503例被诊断为AKI，其中209例需要RRT。排除接受慢性透析和已知患有恶性疾病的患者后，我们对154例患者进行了回顾性分析。高乳酸血症定义为入住ICU时血清乳酸浓度高于4 mmol/L。
患者的平均年龄为62.8岁，69.5%为男性。入住ICU时的平均查尔森合并症指数（CCI）为3.7，56例（36.4%）患者有急性高乳酸血症。所有纳入患者均为AKI 3期并接受RRT治疗，125例（81.2%）接受持续RRT，29例（18.8%）接受间歇性血液透析。在ICU的平均住院时间为15.7±13天，118例（76.6%）患者在60天观察期内死亡。Kaplan-Meier生存分析显示，高乳酸血症患者组的生存率在统计学上显著较低（对数秩检验；p = 0.032）。单因素Cox回归分析显示，入住ICU时的血清乳酸水平显著预测60天生存率（风险比1.075；95%置信区间1.015 - 1.140；p = 0.014）。在多因素Cox回归分析中，纳入了年龄、性别、糖尿病、高血压、慢性肾脏病、估计肾小球滤过率、血清乳酸、CCI和C反应蛋白，只有年龄（风险比1.031；95%置信区间1.007 - 1.056；p = 0.011）和血清乳酸（风险比1.067；95%置信区间1.004 - 1.134；p = 0.035）是死亡率的独立预测因素。
我们的研究强调了入住ICU时血清乳酸水平超过4 mmol/L与接受RRT治疗的AKI患者60天死亡率增加之间的独立关联。这些发现对AKI危重症患者的管理和预后具有重要意义，为血清乳酸在患者预后中的作用提供了新的认识。
注册机构名称：ClinicalTrials.gov；试验注册号：NCT06565403；注册日期，后面跟着“回顾性注册”字样：2024年8月19日；试验注册记录的网址：https://clinicaltrials.gov/study/NCT06565403 。
