Higher Serum Lactate Levels Research Articles

Homozygous Microdeletion Involving Exon 1 of ERCC8 and NDUFAF2 With Uniparental Isodisomy of Chromosome 5

ABSTRACTBackgroundUniparental isodisomy (UPiD) refers to a condition, in which both homologous chromosomes are inherited from only one parental homolog, which can result in either imprinting disorders or autosomal recessive conditions.MethodsWe performed chromosomal microarray analysis, exome sequencing (ES), and RNA sequencing (RNA‐seq) using the patient's urine‐derived cells on a patient with growth retardation and multiple congenital anomalies.ResultsWe identified a homozygous ~0.53 kb microdeletion at 5q12.1, which was transmitted from the father with paternal UPiD(5). The deletion encompassed the first exon of both the ERCC8 and NDUFAF2 genes, which are responsible for Cockayne syndrome (CS) and mitochondrial complex I deficiency, respectively. Furthermore, RNA‐seq confirmed the reduced expression of both genes. Indeed, in addition to clinical features common to both syndromes, such as growth retardation, developmental delay, and feeding difficulties, the patient exhibited blended phenotypes: the characteristic features of CS, including arthrogryposis, microcephaly, and facial dysmorphisms, and those of mitochondrial complex I deficiency, including high serum lactate levels and lethal apnea resulting in a severe clinical course.ConclusionThe results imply that ES in combination with RNA‐seq could be a powerful method for the detection of underlying factors responsible for rare genetic conditions, such as UPD.

Mechanism of lactic acidemia-promoted pulmonary endothelial cells death in sepsis: role for CIRP-ZBP1-PANoptosis pathway

BackgroundSepsis is often accompanied by lactic acidemia and acute lung injury (ALI). Clinical studies have established that high serum lactate levels are associated with increased mortality rates in septic patients. We further observed a significant correlation between the levels of cold-inducible RNA-binding protein (CIRP) in plasma and bronchoalveolar lavage fluid (BALF), as well as lactate levels, and the severity of post-sepsis ALI. The underlying mechanism, however, remains elusive.MethodsC57BL/6 wild type (WT), Casp8−/−, Ripk3−/−, and Zbp1−/− mice were subjected to the cecal ligation and puncture (CLP) sepsis model. In this model, we measured intra-macrophage CIRP lactylation and the subsequent release of CIRP. We also tracked the internalization of extracellular CIRP (eCIRP) in pulmonary vascular endothelial cells (PVECs) and its interaction with Z-DNA binding protein 1 (ZBP1). Furthermore, we monitored changes in ZBP1 levels in PVECs and the consequent activation of cell death pathways.ResultsIn the current study, we demonstrate that lactate, accumulating during sepsis, promotes the lactylation of CIRP in macrophages, leading to the release of CIRP. Once eCIRP is internalized by PVEC through a Toll-like receptor 4 (TLR4)-mediated endocytosis pathway, it competitively binds to ZBP1 and effectively blocks the interaction between ZBP1 and tripartite motif containing 32 (TRIM32), an E3 ubiquitin ligase targeting ZBP1 for proteasomal degradation. This interference mechanism stabilizes ZBP1, thereby enhancing ZBP1-receptor-interacting protein kinase 3 (RIPK3)-dependent PVEC PANoptosis, a form of cell death involving the simultaneous activation of multiple cell death pathways, thereby exacerbating ALI.ConclusionsThese findings unveil a novel pathway by which lactic acidemia promotes macrophage-derived eCIRP release, which, in turn, mediates ZBP1-dependent PVEC PANoptosis in sepsis-induced ALI. This finding offers new insights into the molecular mechanisms driving sepsis-related pulmonary complications and provides potential new therapeutic strategies.

Circulating T-lymphocyte subsets as promising biomarkers for the identification of sepsis-induced acute kidney injury.

This retrospective study investigated whether disturbances in circulating T-lymphocyte subsets could predict the incidence of acute kidney injury (AKI) and in-hospital mortality in patients with sepsis. Clinical data from patients with sepsis admitted to the intensive care unit were reviewed. Logistic regression analyses were used to identify independent predictors of in-hospital mortality and the development of AKI. Of 81 patients with sepsis, 50 developed AKI. Both nonsurvivors and patients with septic AKI exhibited higher Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Nonsurvivors exhibited more organ damage, with significantly lower levels of peripheral T-lymphocyte subsets, including total circulating lymphocytes, and CD3 + , CD3 + CD4 + , and CD3 + CD8 + T-lymphocytes. Patients with septic AKI exhibited fewer total peripheral lymphocytes and fewer CD3 + , CD3 + CD4 + , and CD3 + CD8 + T-lymphocytes, with higher serum lactate levels and lower nadir platelet counts. Independent predictors of 30-day hospital mortality included maximum SOFA and APACHE II scores, occurrence of encephalopathy, and peripheral CD3 + and CD3 + CD8 + T-lymphocyte counts. Moreover, the maximum SOFA score and CD3 + and CD3 + CD8 + T-lymphocyte counts demonstrated good predictive power for AKI in receiver operating characteristic (ROC) curve analyses, with an area under the ROC curve of 0.810 (95% confidence interval [CI], 0.712-0.908) for SOFA score, 0.849 (95% CI, 0.764-0.934) for CD3 + T-lymphocytes, and 0.856 (95% CI, 0.772-0.941) for CD3 + CD8 + T-lymphocytes. Patients with sepsis-induced AKI experienced T lymphopenia and increased in-hospital mortality. Higher maximum SOFA scores and reduced peripheral CD3 + and CD3 + CD8 + T-lymphocyte levels were associated with in-hospital mortality and the development of AKI in patients with sepsis.

Correlation of Serum Lactate and Shock Index as Mortality Predictor in Polytrauma Patients

In polytrauma patients, serum lactate and hypovolemic shock are critical biomarkers for prognosis and treatment guidance. Elevated lactate levels indicate tissue hypoperfusion and anaerobic metabolism, often correlating with increased mortality. Objective: To analyze the correlation between serum lactate levels and shock index as predictors of in-hospital mortality in polytrauma patients. Methods: A Cohort study was conducted from August 2022 to July 2023 at a single tertiary care hospital in Karachi. Patients were chosen via consecutive sampling techniques and included adult patients with polytrauma injuries (ISS ≥ 15) who survived at least 24 hours. Patients with a history of diabetes were excluded. The serum lactate levels and shock index at the time of admission and over the first 24 hours were the exposures while in-hospital mortality, was the primary outcome. Statistical analyses were conducted using Stata 16.0. Categorical variables were analyzed using the chi-square test. Multivariable logistic regression evaluated mortality risk, adjusting for age, ISS, and shock index. Results: The in-hospital mortality rate in the study was 6.4% with significant predictors of mortality included increasing age (47.05 vs. 27.62 years, p<0.001), higher Injury Severity Scores (ISS) (24 vs. 19, p= 0.02), and elevated shock index at admission (0.84 vs. 0.71, p<0.001). Lactate metrics were strongly associated with mortality, showing significant correlations. Conclusions: Higher serum lactate levels and shock index are strong predictors of mortality in polytrauma patients. Greater age and injury severity also contribute to poorer outcomes.

Associations of serum lactate and lactate clearance with delirium in the early stage of ICU: a retrospective cohort study of the MIMIC-IV database.

This study aimed to investigate the associations of serum lactate level [within and after 24 h of the intensive care unit (ICU) admission] and lactate clearance rate with delirium and assess associations of lactate and lactate clearance rate with 30-day mortality in delirium patients. Data in this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database in 2012-2019. The associations of lactate and lactate clearance rate with delirium were explored through univariable and multivariable logistic regression analyses, whereas the associations of lactate and lactate clearance rate with 30-day mortality in delirium patients were investigated using univariable and multivariable Cox regression analyses. Subgroup analysis was performed for age, gender, sepsis, hypertension, sedative drug, ventilation, antibiotic drug, vasopressors, and the Sequential Organ Failure Assessment (SOFA) score. The evaluation indexes were odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs). Among 7,812 (14.58%) eligible participants, 4,338 (8.19%) had delirium and 1,903 (24.36%) died within 30 days. After adjusting for covariates, patients with lactic acidosis (lactate level > 5 mmol/L and PH < 7.35) at T0 (within 24 h of the ICU admission) had higher odds of delirium (OR = 1.235, 95%CI: 1.105-1.382). Hyperlactatemia (lactate level 2-5 mmol/L and PH > 7.35) at T1 (after 24 h of the ICU admission) was also associated with higher odds of delirium (OR = 1.277, 95%CI: 1.126-1.447). Lactate clearance rate > 50% was linked to lower odds of delirium (OR = 0.705, 95%CI: 0.613-0.811), and this relationship was also observed in ≥65 years old, female, male, non-sepsis, sepsis, non-hypertension, non-sedative drug use, sedative drug use, ventilation, antibiotic drug use, use of vasopressors, and different SOFA score subgroups (all p < 0.05). Additionally, hyperlactatemia and lactic acidosis (whether at T0 or T1) may be potential risk factors for 30-day mortality in delirium patients, whereas lactate clearance rate ≥ 0 had a potential protective effect on 30-day mortality (all p < 0.05). Higher serum lactate levels in the early stage of the ICU were associated with a higher risk of delirium and subsequent mortality. Measures taken to increase the lactate clearance rate are necessary to reduce potential delirium or mortality risk in clinical settings. However, more evidence from prospective studies is needed to verify these findings.

Prognostic value of serum lactate level for mortality in patients with acute kidney injury

BackgroundSerum lactate is associated with mortality in diverse kinds of patients. This study aimed to investigate whether serum lactate level may independently predict mortality in acute kidney injury (AKI) patients.MethodsA total of 4461 AKI patients were collected from the Medical Information Mart for Intensive Care (MIMIC III) database and followed up for 365 days. According to serum lactate tertiles, participants were divided into three groups (Q1–Q3) by: Q1 ≤ 1.60 mg/dl, Q2 = 1.61–2.70 mg/dl, and Q3 ≥ 2.71 mg/dl. We calculated the hazard ratio (HR) and 95% confidence intervals (Cls) for mortality across each tertile of lactate by using the Q1 as reference and constructed four models to adjust for the HR of mortality.ResultsNonsurvivors had significantly higher lactate compared with patients in the survival group. Mortality rate gradually elevated with the increase in serum lactate level (Q1: 29.30%, Q2: 33.40%, Q3: 37.40%). When compared with Q1 after adjustment of all confounders, the HRs of Q3 still was 1.20 (95% Cl 1.05–1.37).ConclusionsThis study demonstrated that high serum lactate levels were an independent predictor of mortality in AKI patients.

Association between hypomagnesemia and serum lactate levels in patients with sepsis: a retrospective observational study

BackgroundSepsis-3 emphasizes the recognition of sepsis-induced cellular metabolic abnormalities, and utilizes serum lactate level as a biomarker of cellular metabolic abnormalities. Magnesium plays an important role as a cofactor in glucose metabolism, although it is not well known that magnesium deficiency causes elevated serum lactate levels. Additionally, it remains unclear how magnesium status affects the role of serum lactate levels as a marker of metabolic abnormalities in sepsis. Thus, this study aimed to investigate the association between serum magnesium and lactate levels in patients with sepsis and explore this relationship from the perspectives of time course and circulatory abnormalities.MethodsThis retrospective observational study of adult patients with sepsis was performed at the 16-bed intensive care unit of Jichi Medical University Hospital between June 2011 and December 2017. The relationship between serum magnesium and lactate levels for 5 days from intensive care unit admission was investigated along the time course. Multivariate logistic regression analysis was performed to evaluate the association between serum magnesium and lactate levels during intensive care unit admission.ResultsAmong 759 patients included, 105 had hypomagnesemia (magnesium level < 1.6 mg/dL), 558 had normal serum magnesium levels (1.6–2.4 mg/dL), and 96 had hypermagnesemia (magnesium level > 2.4 mg/dL) at intensive care unit admission. From intensive care unit admission to day 5, the hypomagnesemia group had higher serum lactate levels and a higher frequency of lactic acidosis than the normal magnesium level and hypermagnesemia groups (70% vs. 51.6% vs. 50%; P < 0.001). Hypomagnesemia at intensive care unit admission was independently associated with lactic acidosis, i.e., lactic acid level > 2 mmol/L (odds ratio, 2.76; 95% confidence interval, 1.60–4.76; P < 0.001).ConclusionsHypomagnesemia was associated with serum lactate levels in the early and post-resuscitation phases of sepsis. Further studies are needed to elucidate whether the magnesium status is associated with sepsis-induced cellular and metabolic abnormalities.

High Intraoperative Serum Lactate Level is Associated with Acute Kidney Injury after Brain Tumor Resection.

Postoperative acute kidney injury (AKI) is associated with poor clinical outcomes. Identification of risk factors for postoperative AKI is clinically important. Serum lactate can increase in situations of inadequate oxygen delivery and is widely used to assess a patient's clinical course. We investigated the association between intraoperative serum lactate levels and AKI after brain tumor resection. Demographics, medical and surgical history, tumor characteristics, surgery, anesthesia, preoperative and intraoperative blood test results, and postoperative clinical outcomes were retrospectively collected from 4131 patients who had undergone brain tumor resection. Patients were divided into high (n=1078) and low (n=3053) lactate groups based on an intraoperative maximum serum lactate level of 3.35mmol/L. After propensity score matching, 1005 patients were included per group. AKI was diagnosed using the Kidney Disease Improving Global Outcomes criteria, based on serum creatinine levels within 7 days after surgery. Postoperative AKI was observed in 53 (1.3%) patients and was more frequent in those with high lactate both before (3.2% [n=35] vs. 0.6% [n=18]; P < 0.001) and after (3.3% [n=33] vs. 0.6% [n=6]; P < 0.001) propensity score matching. Intraoperative predictors of postoperative AKI were maximum serum lactate levels > 3.35mmol/L (odds ratio [95% confidence interval], 3.57 [1.45-8.74], P = 0.005), minimum blood pH (odds ratio per 1 unit, 0.01 [0.00-0.24], P = 0.004), minimum hematocrit (odds ratio per 1%, 0.91 [0.84-1.00], P = 0.037), and mean serum glucose levels > 200mg/dL (odds ratio, 6.22 [1.75-22.16], P = 0.005). High intraoperative serum lactate levels were associated with AKI after brain tumor resection.

The association of positive sepsis PCRs tests with patient mortality, length of stay, and antibiotic management in a medical intensive care unit

Background: Polymerase chain reaction (PCR) testing amplifies a specific DNA segment through heat cycling to identify pathogens for the diagnosis of infection. This testing allows for rapid detection of pathogens, before conventional blood culture results become available. The high mortality associated with severe sepsis and septic shock stresses the importance of early diagnosis and initiation of early antibiotic therapy. This study analyzed the association of the sepsis PCR results and antibiotic management, length of stay, and mortality outcomes in a medical intensive care unit (MICU).&#x0D; Methods: This study is a retrospective, cross-sectional study on patients diagnosed with severe sepsis and septic shock based on ICD-10 codes, aged 18 years and older, admitted to the MICU at University Medical Center, Lubbock, Texas, between December 2016 to December 2020.&#x0D; Results: Clinical information from 268 patients with the diagnosis of sepsis or septic shock was collected and analyzed. The mean age was 60.9 ± 15.6 years with a predominance of men (144, 53.7%) and Caucasian race (193,73.4%). A total of 101 patients (37.6%) had positive PCR results; overall, PCR test results had a diagnostic sensitivity of 91.2 %. The concordance between positive blood culture and positive PCR was 93.3 % (p &lt;.0001). There was a significant correlation between PCR positivity and increased serum lactate levels (p=0.03), changes in antibiotics (P&lt;0.00010), and increased mortality rate (p=0.04). There was no significant correlation between PCR positivity and length of stay (p=0.84).&#x0D; Conclusion: In this study, PCR testing was an accurate tool for early identification of bacterial pathogens. A positive PCR was associated with higher serum lactate levels, higher mortality rates, and an increased frequency of antibiotic changes but was not associated with shorter ICU length of stay.&#x0D; Key words: Sepsis, septic shock, PCR testing, outcomes

Prognostic value of procalcitonin in patients with cirrhosis hospitalized for acute infection

Background: In patients with cirrhosis, infections significantly increase the risk of short and long-term mortality. During infection, the levels of procalcitonin increase, but it has not yet been clarified its prognostic value in subjects with cirrhosis. Therefore, the aim of this study was to evaluate the prognostic role of procalcitonin in patients with liver cirrhosis hospitalized for acute infection, and to compare it with other markers of infection. Patients: We included 279 patients hospitalized because of infection, 133 with liver cirrhosis. At admission the levels of the main biochemical parameters of infection, i.e. leukocytes, procalcitonin, C reactive protein and lactate, were considered. Results: The duration of hospitalization and antibiotic therapy were longer in patients with cirrhosis, while no difference was observed for mortality. In both groups, a correlation with the duration of hospitalization and antibiotic therapy was observed for high levels of procalcitonin. In the cirrhotic population, in particular, higher procalcitonin values were associated with an increase in the length of hospitalization and antibiotic therapy, suggesting an even greater predictive value for those patients. High levels of leucocytes and lactate were positively associated with the duration of hospitalization, but not with the duration of antibiotic therapy. For mortality, the strongest correlation was found for high serum lactate levels, regardless of the presence of cirrhosis. Conclusion: In patients with cirrhosis and acute infection, the value of procalcitonin at admission is a good prognostic indicator for the course of hospitalization, and could be useful for guiding the management and treatment of hospitalized patients.

Discrepancy between two invasive blood pressure measurements in patients receiving intra-aortic balloon pump therapy

BackgroundHemodynamic monitoring is imperative for patients with cardiogenic shock undergoing Intra-aortic Balloon Pump (IABP) therapy. Blood pressure monitoring encompasses non-invasive, invasive peripheral arterial pressure (IPAP), and invasive central aortic pressure (ICAP) methods. However, marked disparities exist between IPAP and ICAP. This study examined the discrepancies between IPAP and ICAP and their clinical significance.MethodsA retrospective analysis was conducted on cardiogenic shock patients who underwent IABP therapy and were admitted to the Coronary Care Unit (CCU) of a tertiary hospital in China from March 2017 to November 2022. The Bland–Altman plot illustrated the discrepancy between IPAP and ICAP. A clinically significant difference between ICAP and IPAP measurements was defined as ≥ 10 mmHg, which could necessitate alterations in blood pressure management according to current guidelines that recommend maintaining a mean arterial pressure (MAP) ≥ 70 mmHg.ResultsIn total, 162 patients were included in the final analysis. In patients without vasopressors, the difference between ICAP and IPAP was 5.73 mmHg (95% limits of agreement [LOA], -16.98 to 28.44), whereas, in patients with vasopressors, it was 4.36 mmHg (95% LOA, -17.31 to 26.03). ICAP measurements exceeded IPAP in patients undergoing IABP therapy. However, the difference was not statistically significant between the two groups. Multivariate logistic regression revealed that higher serum lactate levels (Odds ratio [OR], 1.14; 95% confidence interval [CI], 1.03–1.27; p = 0.013) and age ≥ 60 years (OR, 13.20; 95% CI, 1.50–115.51; p = 0.020) were associated with an increased likelihood of a clinically significant MAP discrepancy. Conversely, a history of coronary heart disease was associated with a decreased likelihood (OR, 0.34; 95% CI, 0.13–0.90; p = 0.031).ConclusionsNotable discrepancies between ICAP and IPAP measurements exist in cardiogenic shock patients undergoing IABP therapy. ICAP exceeds IPAP, and factors such as age ≥ 60 years, elevated lactic acid levels, and absence of coronary heart disease contribute to this discrepancy. Enhanced vigilance is warranted for these patients, and the consideration of peripheral invasive monitoring in conjunction with IABP therapy is advised.

Serum lactate and the mortality of critically ill patients in the emergency department: A retrospective study.

Serum lactate levels have been widely studied as a prognostic marker in critically ill patients, particularly those in the intensive care unit. However, it remains unknown whether the serum lactate levels affect the mortality rate of critically ill patients admitted to hospital. To investigate this hypothesis, the vital signs and blood gas analysis data of 1,393 critically ill patients who visited the Emergency Department of Affiliated Kunshan Hospital of Jiangsu University (Kunshan, China) between January and December 2021 were collected. Patients were divided into two groups, 30-day survival group and a 30-day death group, and logistic regression analysis was used to investigate the association between vital signs, laboratory results and mortality rates of critically ill patients. A total of 1,393 critically ill patients was enrolled in the present study, with a male-to-female ratio of 1.17:1.00, a mean age of 67.72±19.29 years and a mortality rate of 11.6%. The multivariate logistic regression analysis revealed that increased serum lactate levels were an independent risk factor for mortality rate of critically ill patients [Odds ratio (OR)=1.50, 95% confidence interval (95% CI): 1.40-1.62]. The critical cut-off value for the serum lactate levels was identified as 2.35 mmol/l. In addition, OR values of age, heart rate, systolic blood pressure, transcutaneous oxygen saturation (SpO2) and hemoglobin were 1.02, 1.01, 0.99, 0.96 and 0.99, respectively (95% CI: 1.01-1.04, 1.00-1.02, 0.98-0.99, 0.94-0.98 and 0.98-1.00, respectively). The logistic regression model was found to be of value in terms of identifying the mortality rate of patients and the area under the receiver operating characteristic curve was 0.894 (95% CI: 0.863-0.925; P<0.001). In conclusion, the present study showed that high serum lactate levels in critically ill patients upon admission to hospital are associated with higher 30-day mortality rate.

Experience of surgical treatments for abdominal inferior vena cava injuries in a regional trauma center in Korea.

Inferior vena cava (IVC) injuries are a rare type of traumatic abdominal injuries that are challenging to treat and have a very high mortality rate. This study described our experience with the surgical treatment of traumatic IVC injuries, and we investigated the demographics, clinical profiles, and surgical outcomes of cases at a regional trauma center. Among the 16 patients who were treated for a traumatic IVC injury between January 2014 and March 2022, 14 underwent surgery. The surgical outcomes included overall mortality and 24-hour mortality, and we investigated the factors associated with these surgical outcomes. The 14 patients were divided into two groups according to the location of the IVC injury (retrohepatic IVC or higher vs. subhepatic IVC), and differences between the two groups were analyzed. A body mass index (BMI) >23.0 kg/m2 (P=0.046), an elevated serum lactate level (P=0.043), and a shorter operation time (P=0.016) were associated with overall mortality. A higher BMI (P=0.050), higher serum lactate level (P=0.004), shorter operation time (P=0.005), and an injury at the retrohepatic IVC or higher level (P=0.031) were associated with 24-hour mortality. Younger age (P=0.028), higher BMI (P=0.005), more acidic pH, higher lactatemia (P=0.012), a higher hemoglobin level (P=0.012), and shorter door-to-operating room time (P=0.028) were associated with injury at the retrohepatic IVC or higher level. Patients with subhepatic IVC injuries had a high rate of direct repair (75.0%) and a significantly lower 24-hour mortality rate (37.5%, P=0.031). Subhepatic IVC injuries are easy to access and are usually expected to treat with a direct repair method. Injuries at the retrohepatic IVC or higher level are difficult to treat surgically and require a systematic and multidisciplinary treatment strategy.

Duration of Invasive Mechanical Ventilation Post-Liver Transplantation: Does One Size Fit All?

Duration of Invasive Mechanical Ventilation Post-Liver Transplantation: Does One Size Fit All?

Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome

BackgroundData about reperfusion injury (RI) following acute arterial mesenteric ischemia (AAMI) in humans are scarce. We aimed to assess the prevalence and risk factors of RI following endovascular revascularization of AMI and evaluate its impact on patient outcomes.MethodsPatients with AAMI who underwent endovascular revascularization (2016–2021) were included in this retrospective cohort. CT performed < 7 days after treatment was reviewed to identify features of RI (bowel wall hypoattenuation, mucosal hyperenhancement). Clinical, laboratory, imaging, and treatments were compared between RI and non-RI patients to identify factors associated with RI. Resection rate and survival were also compared.ResultsFifty patients (23 men, median 72-yrs [IQR 60–77]) were included, and 22 were diagnosed with RI (44%) after a median 28 h (22–48). Bowel wall hypoattenuation and mucosal hyperenhancement were found in 95% and 91% of patients with post-interventional RI, respectively. Patients with RI had a greater increase of CRP levels after endovascular treatment (p = 0.01). On multivariate analysis, a decreased bowel wall enhancement on baseline CT (HR = 8.2), an embolic cause (HR = 7.4), complete SMA occlusion (HR = 7.0), and higher serum lactate levels (HR = 1.4) were associated with RI. The three-month survival rate was 78%, with no difference between subgroups (p = 0.99). However, the resection rate was higher in patients with RI (32% versus 7%; p = 0.03).ConclusionRI is frequent after endovascular revascularization of AAMI, especially in patients who present with decreased bowel wall enhancement on pre-treatment CT, an embolic cause, and a complete occlusion of the SMA. However, its occurrence does not seem to negatively impact short-term survival.

The Association of Elevated Lactate Level and Rate of Intensive Care Unit Admissions, Endoscopies, and Transfusion of Packed Cell in Patients with Acute Gastrointestinal Bleeding

Background: Management of patients with Gastrointestinal Bleeding (GIB) based on chronicity and severity of it can vary from outpatient medical therapy to intensive caring in life-threatening cases. Initial clinical management decision in patients presenting to emergency department with acute GIB is often based on identifying high- and low-risk patients. Patients with high risks of adverse outcomes, such as death or re-bleeding, are more likely to benefit from early, aggressive management, whereas patients with lower risks may be considered for early hospital discharge or even outpatient management. Serum lactate level is generally an indicator of the overall adequacy of peripheral oxygenation. In severe cases of acute GIB, the hemodynamic of the patients disturbs. In this study, we are evaluating whether higher serum lactate level is potentially a biomarker for predicting the future need for special management considerations.&#x0D; Methods: 168 patients with confirmed acute GIB have entered this study. The serum lactate level of participants was measured and documented as well as their demographic data and their medical history. The participants’ need for ICU admission, blood transfusion, emergent endoscopy, and mortality rate were documented and assessed prospectively.&#x0D; Results: Patients with higher levels of serum lactate levels were more admitted to the intensive care unit in the upcoming days. Anticoagulant use and abdominal pain prevalence were also significantly different in the study groups (p&gt;0.05). Other assessments were not statistically significant.&#x0D; Conclusion: Higher levels of serum lactate predict a higher probability of ICU admission in patients with acute GIB.

A two-year cross-sectional study on the impact of serial serum Lactate in comparison with APACHE IV and SOFA Scores in predicting outcomes in patients of sepsis at limited resources rural setup

Objectives: Lactic acid is a metabolite that is physiologically produced and metabolized in a balanced state in the body from glucose. Critically ill patients with sepsis are found to have higher serum lactate levels. In this study, the established Intensive Care Unit (ICU) scores that are Sequential Organ Failure Assessment (SOFA) and Acute physiology and chronic health evaluation (APACHE IV) were compared to serial serum lactate measurements as a superior predictor of mortality in critically ill patients with sepsis admitted under Intensive Care Unit. Methods: In this cross-sectional study, 280 patients who were admitted to ICU care and were diagnosed to have sepsis were enrolled from August 2019 to September 2021. The presentation of the categorical variables was done in the form of numbers and percentages (%). On the other hand, the quantitative data were presented as the means ± SD and as median with 25th and 75th percentiles (interquartile range). The data normality was checked by using the Kolmogorov-Smirnov test. In the cases in which the data was not normal, nonparametric tests were used. Results: An ICU mortality rate of 43.21% was observed among the 280 adult patients diagnosed with sepsis admitted to ICU involved in this study. The interpretation of the area under the Receiver operating curve (ROC) showed that the performance of serum Lactate (mmol/L) on day 3 (Area under the curve [AUC] 0.909; 95% CI: 0.867 to 0.941) was very much comparable to APACHE IV score on day 3(AUC 0.931; 95% CI: 0.893 to 0.960). Serum lactate on day 3 was even better than the SOFA score on day 3(AUC 0.936; 95% CI: 0.898 to 0.963). Among all the parameters, the APACHE IV score on day 3 was the best predictor of mortality at the cut-off point of &gt;132 with a 91.0% chance of correctly predicting mortality. Conclusion: When compared with SOFA and APACHE IV scores, serial serum lactate was reliable and comparable as far as an outcome in terms of mortality is concerned in patients with sepsis admitted to the intensive care unit. Thus, serum lactate can be considered a surrogate marker for predicting mortality in sepsis patients in low-resource rural setups.

Methylene blue dosing strategies in critically ill adults with shock-A retrospective cohort study.

Shock increases mortality in the critically ill and the mainstay of therapy is the administration of vasopressor agents to achieve hemodynamic targets. In the past, studies have found that the NO-pathway antagonist methylene blue improves hemodynamics. However, the optimal dosing strategy remains elusive. Therefore, we investigated the hemodynamic and ICU outcome parameters of three different dosing strategies for methylene blue. We performed a retrospective cohort study of patients in shock treated with methylene blue. Shock was defined as norepinephrine dose >0.1 μg/kg/min and serum lactate level >2 mmol/l at the start of methylene blue administration. Different demographic variables, ICU treatment, and outcome parameters were evaluated. To compare the differences in the administration of vasopressors or inotropes, the vasoactive inotropic score (VIS) was calculated at different time points after starting the administration of methylene blue. Response to methylene blue or mortality at 28 days were assessed. 262 patients from July 2014 to October 2019 received methylene blue. 209 patients met the inclusion criteria. Three different dosing strategies were identified: bolus injection followed by continuous infusion (n = 111), bolus injection only (no continuous infusion; n = 59) or continuous infusion only (no bolus prior; n = 39). The groups did not differ in demographics, ICU scoring system, or comorbidities. In all groups, VIS decreased over time, indicating improved hemodynamics. Cardiogenic shock and higher doses of norepinephrine increased the chance of responding to methylene blue, while bolus only decreased the chance of responding to methylene blue treatment. 28-day mortality increased with higher SAPSII scores and higher serum lactate levels, while bolus injection followed by continuous infusion decreased 28-day mortality. No severe side effects were noted. In this cohort, methylene blue as a bolus injection followed by continuous infusion was associated with a reduced 28-day mortality in patients with shock. Prospective studies are needed to systematically evaluate the role of methylene blue in the treatment of shock.

Serum Lactate as Serum Biomarker for Cardiopulmonary Parameters within the First 24 Hours after a Spontaneous Intracerebral Hemorrhage.

Objective: Cardiopulmonary (CP) complications are well known in patients with an intracerebral hemorrhage (ICH) and could be associated with a higher serum lactate level. The present study aimed to assess the associations between the initial serum lactate level and the CP parameters within the first 24 h of intensive care unit (ICU) treatment in neurosurgical ICH patients. Patients and Methods: A total of 354 patients admitted to the ICU between 01/2009 and 12/2017 with a diagnosis of an ICH were retrospectively analyzed. Blood samples were taken upon admission, and each patient’s demographic, medical, and radiological data upon admission, as well as several CP parameters, were recorded within the first 24 h of ICU treatment. Results: A higher serum lactate level was associated with a lower GCS score (p < 0.0001), as well as a higher Acute Physiology and Chronic Health Evaluation II score (p = 0.002) upon admission. Additionally, patients with initially higher serum lactate levels had a significantly higher need for a norepinephrine application (p = 0.004) and inspiratory oxygen fraction (p = 0.03) within the first 24 h. Conclusion: Neurosurgical ICH patients with higher serum lactate levels upon admission require more CP support within the first 24 h of ICU treatment.

Predicting factors and outcomes of acute myocarditis in children - a 5-year experience in a teaching hospital from the Eastern province of Saudi Arabia.

Myocarditis in children is not very common, but the state of the disease is similar to viral influenza, making it challenging for a clinician to make an early diagnosis and treatment plan. Elevated levels of inflammatory biomarkers like C-reactive protein, serum lactate, troponin, and abnormal ECG may be helpful for high-index suspicion of myocarditis. This study aimed to determine the predicting factors and outcomes of acute myocarditis in children admitted to a teaching hospital in the Eastern province of Saudi Arabia. Complete medical records of 80 pediatric patients with acute myocarditis over 5 years (from 2015 to 2019) were retrieved, including demographic characteristics, laboratory investigations including cardiac enzymes (serum lactate, CPR, and troponin), and ECG findings for the diagnosis of myocarditis based on tachycardia and bradycardia. There were 22 (27.5%) mortalities that took place during the hospital stay. Low WBC (mmol/dl) levels were associated with in-hospital mortality (p 0.001), whereas high serum lactate levels (>2 mmol) were not. Association of troponin level (0.15ng/mL) was not significantly associated with mortality (p=0.496). The area under the ROC=0.947 (95% C.I: 0.88-1.0) revealed highly significant predictive validity at the 2.3 best cutoff point, having 90.9% and 87.9% sensitivity and specificity, respectively. Clinical factors and elevated biomarkers were associated with poor prognosis and in-hospital mortality in pediatric myocarditis. Serum lactate and troponin levels demonstrated high predictive validity for early diagnosis.