Lactate Values Research Articles

Role of serum lactate as prognostic marker of mortality among emergency department patients with multiple conditions: A systematic review.

In the Emergency Department, the physician's purpose is to rapidly and accurately diagnose the severity of a patient's condition so that proper treatment can be administered. Therefore, this study pays close attention to the association and prognostic value of blood lactate on different disease outcomes by systematically reviewing recently published studies. The search strategy was developed based on searches in the year 2022 for potential publications including original articles, case reports, and reviews using the following web databases google scholar, PubMed, and Science Direct. A total of 25 studies were identified and reviewed extensively to evaluate the link between mortality and serum lactate levels. This literature review presents the strong association of elevated serum lactate levels with the in-hospital mortality rate among emergency department patients. These findings suggest that even a moderately raised lactate level in serum can predict the severe outcome in emergency department patients suffering from different conditions. Therefore, early (at the time of administration of hospital) and periodic serum lactate value determination through different techniques and scores is of need and should become part of routine analyses in emergency department to predict and choose therapies that could benefit critically ill patients.

Emergency Department Point-of-Care Tests during Cardiopulmonary Resuscitation to Predict Cardiac Arrest Outcomes.

This study evaluated the role of point-of-care tests (POCT) such as blood lactate, anion gap (AG), base deficit, pH, N-terminal pro B-type natriuretic peptide (NT-proBNP), and troponin as the predictors of cardiac arrest outcomes in the emergency department (ED). We conducted a prospective, observational study in the ED of a tertiary care hospital in India. All the adult patients who received cardiopulmonary resuscitation (CPR) in the ED were included in the study. Blood samples were collected within 10 min of initiation of CPR for assay of POCTs. Outcomes assessed were the return of spontaneous circulation (ROSC), 24-h survival, survival to hospital discharge (STHD), survival at 7 days, and favorable neurological outcome (FNO) at day 7 of admission. One hundred and fifty-one patients were included in the study (median age: 50 years, 65% males). Out of 151 cases, ROSC, survival at 7 days, STHD, and FNO was observed in 86 patients, six patients, five patients, and two patients, respectively. "No-ROSC" could be significantly predicted by raised lactate (odds ratio [OR]: 1.14, 95% confidence interval: 1.07-1.22) and NT-proBNP (OR: 1.05, 1.01-1.09) values at the time of cardiac arrest. "24-h mortality" could be significantly predicted by the raised lactate (OR: 1.14, 1.01-1.28), low arterial pH (OR: 0.05, 0.01-0.52), raised AG (OR: 1.08, 1.01-1.15), and lower base deficit (<-15) (OR: 1.07, 1.01-1.14). None of the other POCTs was found to be a predictor of other cardiac arrest outcomes. Among various POCTs, raised lactate assayed within 10 min of cardiac arrest can predict poor outcomes like "no-ROSC" and 24-h mortality.

Histopathological Changes in the Myocardium Caused by Energy Drinks and Alcohol in the Mid-term and Their Effects on Skeletal Muscle Following Ischemia-reperfusion in a Rat Model.

Although energy drinks have been consumed for many years, their effects on the cardiovascular system continue to be investigated. Today, the most frequently used area of energy drinks is the entertainment sector, and this study investigates the effects of energy drinks and alcohol consumption on rats' limb and myocardium tissue. Forty Wistar Albino rats were used and divided into 4 groups. Energy drinks were given to the first group (the energy drink group), alcohol was given to the second group, and energy drinks and alcohol were given to the third group Redbull-Alcohol (RA). Blood samples, leg muscles, and heart tissues were studied after the ischemia-reperfusion model was created at the infrarenal level. In the histopathological examination of heart muscles, the damage was significantly more severe in the RA group than in the control group (P <.05). There was no significant change in the RA group in the limb muscle; however, muscle fiber abnormality was higher. The energy drink group was more prone to carbon dioxide retention and hypoxia, resulting in respiratory acidosis. (P =.05). Lactate was significantly higher in the energy drink group (P =.002). Glucose concentrations of energy drink and RA groups were higher (P =.02). The high lactate values of the energy drink group and more damaged fibers in the striated muscles in the RA group showed that they are more susceptible to ischemia. Long-term energy drinks and alcohol use may cause damage to the heart muscle and endothelium. Also, the effects of long-term alcohol and energy drink use on the respiratory system should be investigated with more specific studies.

Lower Body Perfusion Reduces the Morbidity of Postoperative Acute Kidney Injury in Type A Dissection: A Propensity-Matched Analysis.

Lower body perfusion (LBP) is a technique used to provide blood perfusion to distal organs and spinal cord during circulatory arrest. However, the effect of LBP on the prognosis of aortic arch surgery, especially on postoperative renal function, remains unclear. A total of 304 patients with acute type A aortic dissection who underwent total aortic arch replacement combined with frozen elephant trunk implantation between May 2016 and December 2021 were retrospectively analyzed. The patients were divided into LBP group (group L, n=85) and non-LBP group (group NL, n=219). Routine lower body circulatory arrest was applied during operation in group NL, and antegrade LBP combined was applied during operation in group L. Perioperative data were recorded. Propensity score matching was used for statistical analysis. After propensity score matching, 85 pairs of patients were successfully matched. Two groups significantly differed in circulatory arrest time (six minutes vs. 30 minutes, P=0.000), cross-clamping time (101 minutes vs. 92 minutes, P=0.010), minimum nasopharyngeal temperature (29.4ºC vs. 27.2ºC, P=0.000), and highest lactate value during cardiopulmonary bypass (2.3 μmol/L vs. 4.1 μmol/L, P=0.000). Considering the postoperative indicators, the drainage volume (450 mL vs. 775 mL, P=0.000) and the incidence of level I acute kidney injury (23.5% vs. 32%, P=0.046) in group L was lower than those in group NL. LBP resulted as a safe and feasible approach in aortic arch surgery, as it could significantly shorten the circulatory arrest time, which might reduce the incidence of postoperative level I acute kidney injury.

Prevalence of Hypocortisolemia in Patients with Sepsis or Septic Shock (The HIS Study) Presenting to the Emergency Department.

Cortisol response to stressors (hypothalamic-pituitary-adrenal axis, autonomic nervous system, and immune system) plays a vital role in maintaining stable metabolic homeostasis. This study was done to assess the prevalence of hypocortisolemia in patients presenting to ED with sepsis and/or septic shock. This prospective observational study was done from July 2020 to April 2021. Serum cortisol levels were measured in patients with sepsis and septic shock, and their clinical and laboratory profile was categorized, coded, and analyzed. Ninety-eight patients were included, of which serum Cortisol <10 μg/dl was noted in 7 (7.2%) patients. The cohort's mean age was 52.9 (SD: 15.3) years with a male predominance (n-61; 62.2%). Most common presenting complaint was fever (n-52; 53.1%), followed by abdominal pain (n-24; 24.5%), and breathing difficulty (n-14; 14.3%). Systolic blood pressure <90 mmHg and tachycardia were seen in 63 patients (64.3%). Assessment of diet and native medication use did not demonstrate a predisposition to hypocortisolemia. The median (IQR) arterial lactate values were lower in the hypocortisolemic group: 2.2 (1.2-2.5) as compared to the non-hypocortisolemic group: 3.7 (2.2-8.0). Patients with septic shock without hypocortisolemia were noted to have a higher mean lactate level (2.6 ± 1.3 Vs 5.4 ± 3.9) and lower platelet counts compared to those with low cortisol levels. Patients with normal cortisol levels (n-38; 38.8%) still had low ACTH values. The prevalence of hypocortisolemia was lower when compared to other Indian studies. Diet and native medication use do not predispose Indians to hypocortisolemia.

Factors Related to Resuscitation Success and Prognosis of Cardiopulmonary Arrest Cases.

In cases where return of spontaneous circulation (ROSC) is provided in the Emergency Department (ED) after cardiopulmonary arrest (CA), it is important to investigate the parameters affecting ROSC rates, to determine the factors affecting the survival status and prognosis in the short and medium term, and to determine to what extent these factors affect the prognosis. This is a cross-sectional study that retrospectively investigates the factors affecting the success of resuscitation over a 5-year period in out-of-hospital cardiac arrest (OHCA) cases. We determined that ROSC was achieved in 26.1% of 1616 adult cardiopulmonary arrest cases, 14.8% survived the first 24 hours, and 3.8% were discharged from the hospital. We determined that ROSC decreased by 21% with a 1-mg increase in the amount of adrenaline used, by 98% with a 1 mmol/L increase in HCO3 (std) value, by 27% with a 1 mmol/L increase in BE (B) value, and by 15% with a 1 mmol/L increase in lactate value. In terms of short-term survival, we found that a 1 mmol/L increase in lactate value reduced the probability of survival by 12%, and a 1 mEq/L increase in K value decreased the probability by 29%. With regard to the probability of survival in the medium term, we determined that the growth in age by 1 year decreased the probability by 4%, and the increase in K value by 1 mEq/L decreased the probability by 35%. Tekin FC, Köylü R, Köylü O, Kunt M. Factors Related to Resuscitation Success and Prognosis of Cardiopulmonary Arrest Cases. Indian J Crit Care Med 2023;27(1):26-31.

Çocuk Acile Karbonmonoksit Zehirlenmesi ile Başvuran Hastaların Değerlendirilmesi

Aim: Carbon monoxide poisoning is one of the significant causes of intoxication and presentation to pediatric emergency departments, especially in winter. The primary aim of this study was to evaluate the demographic characteristics, and clinical and laboratory findings of pediatric patients who presented to the pediatric emergency department with carbon monoxide poisoning, and the secondary aim was to examine the laboratory values of the patients with impaired consciousness. Material and Methods: The demographic and clinical characteristics and laboratory values of 162 patients presented to the pediatric emergency department due to carbon monoxide poisoning between 2017 and 2020 were retrospectively analyzed. The laboratory parameters of the patients with and without symptoms of impaired consciousness were compared. Results: The mean age of the patients was 8.94±5.33 years, and the gender distribution was homogenous. The highest frequency of presentation was during winter. Nausea, vomiting, and headache were the most common symptoms. Fifteen of the patients had impaired consciousness. While the laboratory values of the patients were generally within normal ranges, patients with high carboxyhemoglobin, lactate, and troponin values, and low pH were encountered. The carboxyhemoglobin and lactate levels of patients with impaired consciousness were found to be significantly higher than the patients without impaired consciousness (p&amp;lt;0.001 and p=0.019, respectively). Conclusion: Elevated carboxyhemoglobin and lactate levels were associated with impaired consciousness. Although carboxyhemoglobin levels are important for diagnosis and clinical follow-up, they should not be used as the only marker. High lactate and troponin levels, and low pH should also be taken into account.

Frequency of blood lactate elevation following esophagectomy and its association to postoperative complications.

Esophagectomy is a major surgical intervention and a cornerstone in the treatment of esophageal cancer. There is clinical experience that blood lactate concentration often is elevated in the period following esophagectomy, but the incidence and clinical consequences are sparsely studied. We extracted data from all patients undergoing esophagectomy at Karolinska University Hospital 2016-2018, n= 153. Most were performed with minimally invasive technique, n= 130. Blood lactate values directly after surgery, highest value during the first night, and morning level on postoperative day one were recorded. Primary outcome was hospital length of stay and secondary outcome was a composite of postoperative infection, additional surgery, or intensive care during the hospital stay. Development of anastomotic leak was analyzed separately. Postoperative hyperlactatemia was common as 93% of patients had peak lactate concentration >1.6 mmol/L and 27% >3.5 mmol/L in the first night following operation. Median hospital length of stay was 14 days. Blood lactate showed a weak correlation to hospital stay and intensive care the morning following surgery, but not at arrival to postoperative ward. There were no statistical differences between those with and without anastomotic leak at any of the time points. Elevated lactate in the first 12-16 h postoperatively was related to surgical factors (open technique, surgery time, and perioperative bleeding) but not to patient related factors (ASA-class, Charlson comorbidity index, sex, age) or cumulative fluid balance. In conclusion, elevated blood lactate in the immediate time following esophagectomy showed a weak association to intensive care and length of stay but not anastomotic leak.

Correlation between Thyroid Responses and Inflammatory Cytokines in Critically Ill COVID-19 Patients.

Mechanisms involved in thyroid dysfunction in critically ill coronavirus disease 2019 (COVID-19) patients are not clear. Our objective was to correlate the thyroid response with the pro- and anti-inflammatory cytokines profile in critically ill COVID-19 patients. This was a prospective single-center study. We studied the relationship between continuous variables by using Pearson correlation and simple linear regression. Multiple logistic regression analysis was performed to analyze the factors independently associated with mortality. Seventy-eight patients were included in the study at intensive care unit (ICU) admission and 72 had a measurement of the thyroid and inflammatory profile at day 5. No significant correlations were found between thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4) and inflammatory cytokines at ICU admission. At day 5, fT4, was inversely correlated with IL-10 (p = 0.035). IL-10 was associated with maximum lactate (p &lt; 0.001) and SOFA score values (p = 0.012). The multiple logistic regression analysis showed that there was a significant relationship between IL-10 (day 5) and in-hospital mortality after adjusting by age and severity of illness. In conclusion, we found that the thyroid hormone profile and inflammatory cytokines had a weak correlation at ICU admission. Associations of interest between fT4 and IL-10 were found at day 5. IL-10 at day 5 was found to be correlated with low fT4 and markers of organ failure and death.

Real-Time Cell Growth Control Using a Lactate-Based Model Predictive Controller

Providing a cost-efficient feeding strategy for cell expansion processes remains a challenging task due to, among other factors, donor variability. The current method to use a fixed medium replacement strategy for all cell batches results often in either over- or underfeeding these cells. In order to take into account the individual needs of the cells, a model predictive controller was developed in this work. Reference experiments were performed by expanding human periosteum derived progenitor cells (hPDCs) in tissue flasks to acquire reference data. With these data, a time-variant prediction model was identified to describe the relation between the accumulated medium replaced as the control input and the accumulated lactate produced as the process output. Several forecast methods to predict the cell growth process were designed using multiple collected datasets by applying transfer function models or machine learning. The first controller experiment was performed using the accumulated lactate values from the reference experiment as a static target function over time, resulting in over- or underfeeding the cells. The second controller experiment used a time-adaptive target function by combining reference data as well as current measured real-time data, without over- or underfeeding the cells.

Whey Powder Supplementation Changes Chemical Composition, Improves Fermentation Quality, Increases the Utilization of Nutrients and Net Energy Lactation Value of Alfalfa Haylage in Kıvırcık Rams

The aim of this study was to reveal the effect of whey powder (WP) supplementation on chemical composition, silage fermentation, in vivo digestibility and net energy lactation (NEL) value of high dry matter (DM) alfalfa silage (Haylage). Alfalfa treated with different doses WP (0, 2, and 4%) were ensiled in plastic cans for 60 days. Nine Kıvırcık rams were used to estimated digestibilities of haylages in 3x3 Latin Square design with fifteen days experimental period. According to the results, the addition of WP significantly increased the DM of alfalfa haylage compared to the control whereas decreased ether extract, crude protein and crude ash. But, cell wall fraction rates of all groups were similar. Relative feed value and physical characteristics other than color improved in WP supplemented groups, and lactic acid rates increased in these groups. In terms of silo acids, the best values were found in the group with 4% WP. On the other hand, the addition of WP increased the organic matter digestibility of haylages, however the effect on other in vivo digestibility of crude protein, crude fiber, nitrogen free extract and neutral detergent fiber was insignificant. Moreover, total digestible nutrients (TDN) and NEL values of haylages were found to be improved with the addition of WP. As a result, it was concluded that in order to obtain quality haylage in the ensiling of high DM and long chopped alfalfa, WP generally can be used as an alternative source of carbohydrates and a 4% whey powder dose can be recommended in the production of haylage especially in the sense of improving silage fermentation.

Association of point-of-care blood variables obtained from dogs and cats during cardiopulmonary resuscitation and following return of spontaneous circulation with patient outcomes.

To investigate the association of point-of-care biochemical variables obtained during CPR or within 24hours of return of spontaneous circulation (ROSC) with patient outcomes. Retrospective study. University teaching hospital. Ninety-four dogs and 27 cats undergoing CPR according to the Reassessment Campaign on Veterinary Resuscitation guidelines. None. Blood gas, acid-base, electrolyte, glucose, and plasma lactate values obtained during CPR or within 24hours of ROSC were retrospectively evaluated and are described. The blood sample type and collection time with respect to CPR initiation and ROSC were recorded. Measured variables, collection times, and species were included in a multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval of ROSC, sustained ROSC (≥20min), and survival to hospital discharge. Significance was set at P<0.05. Seventy-two venous blood samples obtained during CPR and 45 first venous and arterial blood samples obtained after ROSC were included in logistic regression analysis. During CPR, PvO2 (1.09 [1.036-1.148], P=0.001) and venous standard base excess (SBE) (1.207 [1.094-1.331], P<0.001) were associated with ROSC. PvO2 (1.075 [1.028-1.124], P=0.002), SBE (1.171 [1.013-1.353], P=0.032), and potassium concentration (0.635 [0.426-0.946], P=0.026) were associated with sustained ROSC. Potassium concentration (0.235 [0.083-0.667], P=0.007) was associated with survival to hospital discharge. Following ROSC, pH (69.110 [4.393-1087], P=0.003), potassium concentration (0.222 [0.071-0.700], P=0.010), and chloride concentration (0.805 [0.694-0.933], P=0.004) were associated with survival to hospital discharge. Biochemical variables such as PvO2 , SBE, and potassium concentration during CPR and pH, potassium, and chloride concentration in the postarrest period may help identify dogs and cats with lower odds for ROSC or survival to hospital discharge following CPR.

Association Between Lactate and 28-Day Mortality in Elderly Patients with Sepsis: Results from MIMIC-IV Database.

This study aimed to explore the association of serum lactate with clinical outcomes in elderly patients with sepsis based on data from the MIMIC-IV database. All elderly patients with sepsis (age ≥ 65years) were included. Different models were constructed for exploring the relationships between lactate and 28-day mortality. A two-segment linear regression model was performed to verify the threshold effects of lactate on clinical outcomes and smooth curve fitting was performed. A total of 4199 elderly patients with sepsis were included. The 28-day mortality was 32.22% (n = 1395). After adjustment for all potential cofounders, for each 1mmol/l increment in lactate, the odds ratio (OR) of 28-day mortality was 1.23 (95% CI 1.18-1.28, P < 0.0001). Smooth fitting curves indicated a non-linear positive relationship between lactate and 28-day mortality. The turning point of lactate level was 5.7mmol/l: at ≤ 5.7mmol/l, with each 1mmol/l increment in lactate, the risk of 28-day mortality increased significantly (OR 1.32, 95% CI 1.25-1.38, P < 0.0001); the significantly positive relationship was still present at lactate > 5.7mmol/l (OR 1.10, 95% CI 1.04-1.18, P = 0.0019). The area under the ROC curve (AUC) of lactate was 0.618 (95% CI 0.599-0.635) and the cutoff value of lactate was 2.4mmol/l with a sensitivity of 0.483 and a specificity of 0.687. In elderly patients with sepsis, a non-linear positive relationship was discovered between serum lactate and 28-day mortality. Physicians should be alert to lactate assessment at admission and pay more attention to those patients with higher levels of lactate.

The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically Ill patients: a retrospective cohort study.

The mortality rate is high in critically ill patients due to the difficulty of diagnosis and treatment. Thus, it is very important to explore the predictive value of different indicators related to prognosis in critically ill patients. This was a retrospective cohort study of patients in the intensive care unit (ICU) of the Sixth People's Hospital in Shanghai, China. A total of 1465 ICU patients had lactate values > 2.1mmol/L at least once within 24h of ICU admission, and arterial blood gas was monitored more than twice during the ICU stay. The predictive value of lactate clearance at 24h was not high, and the sensitivity and specificity were lower. The predictive value of the lactate level at baseline and the APACHE II score was higher than that of lactate clearance at 24h in critically ill patients. The predictive value of the lactate level at baseline combined with the APACHE II score was higher than that of the lactate level at baseline or the APACHE II score alone. In addition, the predictive value of lactate clearance at 24h combined with the APACHE II score was also significantly higher than that of lactate clearance at 24h or the APACHE II score alone. In particular, the area under the ROC curve reached 0.900, the predictive value was markedly higher than that of the ROC alone, and the sensitivity and specificity were better when these three indicators were combined. The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically ill patients.

Invasive hemodynamic monitoring for fluid management in septic shock patients

Aim Sepsis is still one of the most common causes of death, despite advances in treatment and technologies. Invasive monitoring in sepsis can improve survival. In this study, we aimed to compare the efficacy of hemodynamic monitoring in the fluid treatment of patients with septic shock. Material and Method Forty septic shock patients were divided into two groups. Group I (n = 20) was monitored with central venous pressure, and Group II (n = 20) with a cardiac output device (EV1000). Arterial blood gases were analyzed four times daily for the groups, and lactate values, diuresis status, need for dialysis, and inotrope need was recorded. For Group I, the central venous pressure and mean arterial pressure values were recorded for group II, cardiac output, cardiac index, stroke volume, stroke volume index, and mean arterial pressure values. Results There was a significant difference between the mean arterial pressures of the groups on the 1st and 2nd days (p = 0.034 and p = 0.026, respectively). In Group II, mean arterial pressures were higher on days 1 and 2. There was no significant difference between the other data recorded. Conclusion We observed no significant difference between central venous pressure monitoring and invasive monitoring in septic shock patient follow-up.

Impact of Lactate on 30-Day All-Cause Mortality in Patients with and without Out-of-Hospital Cardiac Arrest Due to Cardiogenic Shock.

In patients with cardiogenic shock (CS) due to myocardial infarction, elevated lactate levels are known to be negative predictors. Studies regarding the prognostic impact in patients with CS complicated by out-of-hospital cardiac arrest (OHCA) are limited. Two hundred and sixty-three consecutive patients with CS were included. The prognostic value of lactate on days 1, 2, 3, 4 and 8 was tested stratified by OHCA and non-OHCA. Statistical analyses included the univariable t-test, Spearman's correlation, C-statistics, Kaplan-Meier analyses, as well as multivariable mixed analysis of variance (ANOVA) and Cox proportional regression analyses. The primary endpoint of all-cause mortality occurred in 49.4% of the non-OHCA group and in 63.4% of the OHCA group. Multivariable regression models showed an association of lactate values with 30-day all-cause mortality in the non-OHCA (p = 0.024) and OHCA groups (p = 0.001). In Kaplan-Meier analyses, patients with lactate levels ≥ 4 mmol/L (log-rank p = 0.001) showed the highest risk for 30-day all-cause mortality in the non-OHCA as well as in the OHCA group. However, in C-statistics lactate on days 1 and 8 had a better discrimination for 30-day all-cause mortality in the OHCA group compared to the non-OHCA group. In conclusion, patients presenting with CS lactate levels showed a good prognostic performance, with and without OHCA. Especially, lactate levels on days 1 and 8 were more accurate in the discrimination for all-cause mortality in CS-patients with OHCA.

Cerebrospinal Fluid Lactate Levels along the Alzheimer’s Disease Continuum and Associations with Blood‐Brain Barrier Integrity, Age, Cognition and Biomarkers

AbstractBackgroundCerebrospinal fluid (CSF) lactate levels have been suggested to be associated with disease severity and progression in several neurological diseases as an indicator of impaired energy metabolism, neuronal death or microglial activation. A small number of studies have examined CSF lactate levels in dementia due to Alzheimer’s disease (AD) and found higher values in AD patients compared to healthy controls (HC). However, these studies were mostly small in size, the inclusion criteria were not always well defined, and the diagnostic value and pathophysiological significance of CSF lactate in AD remains unclear.MethodsWe examined CSF lactate levels and potentially associated factors in a large (n=312), biologically and clinically well‐defined sample of patients with AD at the stage of mild cognitive impairment (MCI‐AD) and dementia (ADD), HC, and patients with frontotemporal lobar degeneration (FTLD).ResultsContrary to previous studies, patients with ADD and HC did not differ in CSF lactate levels. However, we found higher values for patients with MCI‐AD compared to those with ADD and to HC in univariate analysis, as well as for MCI‐AD compared to ADD when controlling for age and blood‐brain barrier integrity. CSF lactate levels were associated with age and blood‐brain barrier integrity but not with clinical severity or CSF biomarkers of AD.ConclusionCSF lactate does not indicate biological or clinical disease severity in AD, nor does it differentiate between patients with AD and healthy controls or patients with FTLD. However, higher CSF lactate levels were found in earlier stages of AD, which might be interpreted in the context of inflammatory processes.

Comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock model

BackgroundThe gut has been hypothesized to be a protagonist tissue in multiple organ dysfunction syndrome (MODS) for the past three decades. Gastric reactance (XL) is a potential perfusion marker derived from gastric impedance spectroscopy (GIS), which is an emerging tool through which living tissue can be continuously measured to determine its pathophysiological evolution. This study aimed to compare the performance of XL [positive predictive values (PPV), negative predictive values (NPV), and area under the curve (AUC)] against commonly used perfusion markers before and during hypovolemic shock in swine subjects.MethodsProspective, controlled animal trial with two groups, control group (CG) N = 5 and shock (MAP ≤ 48 mmHg) group (SG) N = 16. Comparison time points were defined as T-2 (2 h before shock), T-1 (1 h before shock), T0 (shock), T1 (1 h after shock), and T2 (2 h after shock). Shock severity was assessed through blood gases, systemic and hemodynamic variables, and via histological examination for assessing inflammation-edema and detachment in the gastric mucosa. Macroscopic assessment of the gastric mucosa was defined in five levels (0—normal mucosa, 1—stippling or epithelial hemorrhage, 2—pale mucosa, 3—violet mucosa, and 4—marmoreal mucosa). Receiver Operating Characteristic (ROC) curves of perfusion markers and XL were calculated to identify optimal cutoff values and their individual ability to predict hypovolemic shock.ResultsComparison among the CG and the SG showed statistically significant differences in XL measurements at T-1, T0, T1, and T2, while lactate showed statistically significant differences until T1 and T2. Statistically significant differences were detected in mucosa class (p < 0.001) and in inflammation-edema in the gastric body and the fundus (p = 0.021 and p = 0.043). The performance of the minimum XL value per subject per event (XL_Min) was better (0.81 ≤ AUC ≤ 0.96, 0.93 ≤ PPV ≤ 1.00, 0.45 ≤ NPV ≤ 0.83) than maximum lactate value (Lac_Max) per subject per event (0.29 ≤ AUC ≤ 0.82, 0.82 ≤ PPV ≤ 0.91, 0.24 ≤ NPV ≤ 0.82). Cutoff values for XL_Min show progressive increases at each time point, while cutoff values for Lac_Max increase only at T2.ConclusionsXL proved to be an indirect and consistent marker of inadequate gastric mucosal perfusion, which shows significant and detectable changes before commonly used markers of global perfusion under the hypovolemic shock conditions outlined in this work.

Admission lactate level and the GRACE 2.0 score are independent and additive predictors of 30-day mortality of STEMI patients treated with primary PCI-Results of a real-world registry.

In many of the risk estimation algorithms for patients with ST-elevation myocardial infarction (STEMI), heart rate and systolic blood pressure are key predictors. Yet, these parameters may also be altered by the applied medical treatment / circulatory support without concomitant improvement in microcirculation. Therefore, we aimed to investigate whether venous lactate level, a well-known marker of microcirculatory failure, may have an added prognostic value on top of the conventional variables of the "Global Registry of Acute Coronary Events" (GRACE) 2.0 model for predicting 30-day all-cause mortality of STEMI patients treated with primary percutaneous coronary intervention (PCI). In a prospective single-center registry study conducted from May 2020 through April 2021, we analyzed data of 323 cases. Venous blood gas analysis was performed in all patients at admission. Nested logistic regression models were built using the GRACE 2.0 score alone (base model) and with the addition of venous lactate level (expanded model) with 30-day all-cause mortality as primary outcome measure. Difference in model performance was analyzed by the likelihood ratio (LR) test and the integrated discrimination improvement (IDI). Independence of the predictors was evaluated by the variance inflation factor (VIF). Discrimination and calibration was characterized by the c-statistic and calibration intercept / slope, respectively. Addition of lactate level to the GRACE 2.0 score improved the predictions of 30-day mortality significantly as assessed by both LR test (LR Chi-square = 8.7967, p = 0.0030) and IDI (IDI = 0.0685, p = 0.0402), suggesting that the expanded model may have better predictive ability than the GRACE 2.0 score. Furthermore, the VIF was 1.1203, indicating that the measured lactate values were independent of the calculated GRACE 2.0 scores. Our results suggest that admission venous lactate level and the GRACE 2.0 score may be independent and additive predictors of 30-day all-cause mortality of STEMI patients treated with primary PCI.

Serum cardiac troponin i and lactate as prognostic markers of Canine African Trypanosomiasis

The study was aimed at understanding the nature and pattern of serum lactate, cardiac troponin I changes associated with acute Trypanosoma brucei infection of dogs. It also seeks to investigate the usefulness of these biomarkers in monitoring disease progression and predicting mortality. Twenty healthy adult dogs of both sexes were used for the study. All the dogs were intra-peritoneally inoculated with 1ml of phosphate buffered saline diluted blood containing 1x106 of Lafenwa strain of T. brucei. The serum lactate, cardiac troponin I, potassium, sodium, chloride and bicarbonate were monitored before and at 16 and 24 days after infection. There was a progressive increase in serum values of lactate, cardiac troponin I and potassium at various days after infection. A significant association was found between lactate and heart rate, chloride and heart rate, potassium and cardiac troponin I. This result has shown that there could be myocardial damage due to hypoxia of anemia and hypo-perfusion in canine African trypanosomiasis. The progressive increase in serum lactate and cardiac troponin I could help in predicting severity and outcome of Canine African Trypanosomiasis. The Lactic acidosis may increase ventilation drive and consequently the heart rates of infected dogs.