Abstract
IntroductionHyperlactatemia is frequent in critically ill patients and is often used as a marker of adverse outcome. However, studies to date have focused on selected intensive care unit (ICU) populations. We sought to determine the occurrence and relation of hyperlactatemia with ICU mortality in all patients admitted to four ICUs in a large regional critical care system.MethodsAll adults ([greater than or equal to] 18 years) admitted to ICUs in the Calgary Health Region (population 1.2 million) during 2003 to 2006 were included retrospectively. Lactate determinations were at the discretion of the attending service and hyperlactatemia was defined by a lactate level > 2 mmol/L.ResultsA total of 13,932 ICU admissions occurred among 11,581 patients. The median age was 63 years (37% female), the mean APACHE II score was 25 ± 9 (n = 13,922). At presentation (within first day of admission), 12,246 patients had at least one lactate determination and the median peak lactate was 1.8 (IQR 1.2 to 2.9) mmol/L. The cumulative incidence of at least one documented episode of hyperlactatemia was 5578/13,932 (40%); 5058 (36%) patients had hyperlactatemia at presentation, and a further 520 (4%) developed hyperlactatemia subsequently. The incidence of hyperlactatemia varied significantly by major admitting diagnostic category (P < 0.001) and was highest among neuro/trauma patients 1053/2328 (45%), followed by medical 2047/4935 (41%), other surgical 900/2274 (40%), and cardiac surgical 1578/4395 (36%). Among a cohort of 9107 first admissions with ICU stay of at least one day, both hyperlactatemia at presentation (712/3634 (20%) vs. 289/5473 (5%); P < 0.001) and its later development (101/379 (27%) vs. 188/5094 (4%); P < 0.001) were associated with significantly increased case fatality rates as compared with patients without elevated lactate. After controlling for confounding effects in multivariable logistic regression analysis, hyperlactatemia was an independent risk factor for death.ConclusionsHyperlactatemia is common among the critically ill and predicts risk for death.
Highlights
Hyperlactatemia is frequent in critically ill patients and is often used as a marker of adverse outcome
Critical Care Vol 13 No 3 Khosravani et al it is recognized that hyperlactatemia is a common occurrence in critically ill patients and is associated with increased mortality, and that the resolution of hyperlactatemia is associated with increased survival, previous studies have focused on relatively small cohorts of selected critically ill populations [1,2,3,5,6,7,9,10,11,12]
The occurrence of hyperlactatemia varied significantly by major admitting diagnostic category (P < 0.001), with the highest cumulative incidence observed among neuro/trauma patients (1053/2328; 45%), followed by medical (2047/4935; 41%), other surgical (900/ 2274; 40%), and cardiac surgical (1578/4395; 36%)
Summary
Hyperlactatemia is frequent in critically ill patients and is often used as a marker of adverse outcome. Elevations of blood lactate are common in patients admitted to the intensive care unit (ICU) and have been associated with adverse outcomes [1,2,3,4,5,6,7]. Studies suggested that venous lactate levels on admission to medical ICUs in patients with shock were associated with mortality rates of greater than 30% with associated correlation with the absolute lactate concentration [1,2,3,4]. The objective of the present study was to assess the incidence of hyperlactatemia and the factors associated with it in a large population of critically ill adult medical and surgical patients, and assess the effect of hyperlactatemia on mortality
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