Mean Serum Lactate Research Articles

Prognostic accuracy of mean arterial pressure and serum lactate level in patients with acute myocardial infarction.

Mean arterial pressure (MAP) can be used to evaluate macro-circulatory perfusion while serum lactate concentration is a marker of tissue perfusion. It is important to note that the primary objective of initial medical interventions is to restore microcirculatory perfusion rather than focusing solely on macro-hemodynamics. We aimed to investigate the prognostic value of the combination of MAP and serum lactate levels measured on admission to the hospital in relation to patients' 30-day survival rate in patients with acute myocardial infarction (MI). Data from 532 consecutive patients with acute MI treated with percutaneous coronary intervention were analyzed. The study endpoint was 30-day all-cause mortality. We found that both MAP and lactate levels were relevant predictors of the 30-day mortality in multivariable Cox regression analysis (HR, 0.83; 95% CI, 0.71-0.97; P = 0.02 and HR, 1.16; 95% CI, 1.06-1.16; P = 0.01, respectively). There was a significant increase in the prognostic performance in relation to 30-day mortality for the combination of both MAP and lactate levels in comparison to MAP alone (P = 0.03 for comparison between areas under the curve). Conversely, the combination of MAP and lactates did not add a significant prognostic value in comparison to lactates alone (P = 0.53 for comparison between areas under the curve). In patients with acute MI, serum lactate level seems to have a higher prognostic value in comparison to MAP. Our data suggest that on initial assessment of patients with acute myocardial infarction, we should move toward a tissue perfusion-based approach instead of focusing on a blood pressure-oriented strategy alone.

Structured Weaning From the Impella Left Ventricular Micro-Axial Pump in Acute Myocardial Infarction With Cardiogenic Shock and Protected Percutaneous Coronary Intervention: Experience From a Non-Cardiac Surgical Centre

The Impella (Abiomed, Danvers, MA, USA) temporary percutaneous left ventricular assist device is increasingly used as mechanical circulatory support in patients with acute myocardial infarction-cardiogenic shock (AMICS) or those undergoing high-risk protected percutaneous coronary intervention (PCI). The optimal weaning regimen remains to be defined. We implemented a structured weaning protocol in a series of 10 consecutive patients receiving Impella support for protected PCI or AMICS treated with PCI in a high volume non-cardiac surgery centre. Weaning after revascularisation was titrated to native heart recovery using both haemodynamic and echocardiographic parameters. Ten patients (eight male, two female; aged 43-70 years) received Impella support for AMICS (80%) or protected PCI (20%). Cardiogenic shock was of Society for Cardiac Angiography & Interventions grade C-E of severity in 80%, and median left ventricular end-diastolic pressure was 31 mmHg. Protocol implementation allowed successful weaning in eight of 10 patients with a median support time of 29 hours (range, 4-48 hours). Explantation was associated with an increase in heart rate (81 vs 88 bpm; p=0.005), but no significant change in Cardiac Index (2.9 vs 2.9 L/min/m2), mean arterial pressure (79 vs 82 mmHg), vasopressor requirement (10% vs 10%), or serum lactate (1.0 vs 1.0). Median durations of intensive care and hospital stay were 3 and 6 days, respectively. At 30 days, the mortality rate was 20%, with median left ventricular ejection fraction of 40%. A structured and dynamic weaning protocol for patients with AMICS and protected PCI supported by the Impella device is feasible in a non-cardiac surgery centre. Larger studies are needed to assess generalisability of such a weaning protocol.

Warburg effect mimicking inborn errors of metabolism in childhood hematologic malignancies: A case-based systematic review.

Type B lactic acidosis and hypoglycemia can occur in various pediatric conditions. In young children with a history of fasting preceding these metabolic derangements, inborn errors of metabolism should be primarily considered. However, the Warburg effect, a rare metabolic complication, can also manifest in children with hematologic malignancies. Only a few reports of this condition in children have been published in the literature. To identify the clinical course, treatment strategies, and outcomes of childhood hematologic malignancies with type B lactic acidosis. We performed a comprehensive search of the PubMed, Scopus, and Cochrane databases without any time restriction but limited to English language articles. The databases were last accessed on July 1st, 2023. A total of 20 publications were included in the analysis, all of which were case reports or case series. No higher quality evidence was available. Among children with hematologic malignancies and Warburg effect, there were 14 cases of acute lymphoblastic leukemia and 6 cases of non-Hodgkin's lymphoma including our illustrative case. Lactic acidosis occurred in 55% of newly diagnosed cases and 45% of relapsed cases. The mean age was 10.3 ± 4.5 years, and 80% of cases were male. The mean serum lactate was 16.9 ± 12.6 mmol/L, and 43.8% of the cases had concomitant hypoglycemia. Lactic acidosis initially subsided in 80% of patients receiving chemotherapy compared to 60% in the contrast group. The mortality rate of newly diagnosed cases was 45.5%, while the relapsed cases represented a 100% mortality rate. All 8 patients reported before 2001 died from disease-related complications. However, patients described in reports published between 2003 and 2023 had a 54.5% rate of complete remission. This complication has historically led to fatal outcome; however, patients who received chemotherapy showed a more favorable response. Therefore, it is crucial to promptly initiate specific treatment in this context.

Utility of Lactate to Bilirubin Index in Predicting Short-Term Mortality in Acute on Chronic Liver Failure: A Single Centered Study

Introduction: Most of the lactate in the body is cleared in the liver. Tissue hypoxia results in increased production of lactate and decreased utility of it. Hepatic insult results not only an increase in the blood lactate levels but also is an independent prognostic marker in critically ill cirrhotic patients. Alteration of liver function is indicated by rise in serum bilirubin. The aim of this study was to therefore to assess the utility of blood lactate to Bilirubin index (LBi) in predicting mortality in patients with acute on chronic liver failure (ACLF).
 Methods: This prospective observational study was conducted from January 2019 to June 2021 at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation. Patients aged > 12 years and presenting ACLF were included and their baseline characteristics were recorded. Primary outcome was observed in terms of 30-days mortality and secondary outcome was six months mortality. These indices were then used to calculate the lactate to bilirubin index (LBi) as [1000 × lactate (mmol/L) × bilirubin (µmol/L)]/2. Area under Receiver operating curves (AUROC) for LBi, Child Turcotte Pugh score(CTP) and Model for End-stage Liver Disease score (MELD) were obtained in predicting both 30 days and six months mortality and at an optimal cutoff sensitivity, specificity and diagnostic accuracy for these scores were calculated.
 Results: A total number 159 patients with ACLF were included in the study. Most of the patients were young with mean age of 35.1 ±16.8 years. Males were 97(61%). Hepatitis C was the most common cause of chronic liver disease followed by hepatitis B and autoimmune hepatitis seen in 41 (25.8%), 39(24.5%) and 36 (22.6%) respectively. Hepatitis E was the most common cause of acute injury noted in 60 (37.7%) patients. The baseline characteristics showed mean serum lactate levels of 0.93±1.33 mmol/L, bilirubin levels of 258.5 ± 155.3 µmol/L, CTP score of 10.7 ± 1.8 and MELD score of 26 ±7.6. Out of 159 patients, 26 (16.4%) patients died within 30 days due to ACLF related complicaitons while 133 (83.6%) were discharged. AUROC obtained for LBi, CTP score and MELD score in predicting 30-day mortality in ACLF was 0.98, 0.79 and 0.78 respectively. A cut off of ≥11.8 for LBi Index, ≥30 for MELD score and ≥13 for CTP score were significantly associated with increased risk of 30-day mortality in ACLF patients in our population. However, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of LBi in predicting 30-day mortality was significantly higher than that of CTP and MELD score. The diagnostic accuracy of LBi in predicting 30 days mortality was 87.5%. Similarly, AUROC obtained for LBi, CTP score and MELD score in predicting 6-month mortality in ACLF was 0.89, 0.72 and 0.66 respectively and the diagnostic accuracy of LBi dropped down to 76.6% with a sensitivity of 49.28%, specificity of 97.28%, PPV of 94.4% and NPV of 71.54%. 
 Conclusion: Our results showed that LBi score of >11.8 had an excellent sensitivity and specificity in predicting mortality in ACLF with an excellent diagnostic accuracy in predicting one month mortality as compared to the other scores. However, its utility in predicting long term mortality is yet to be proven. Further studies are needed to validate this index.

Anion gap(AG) or serum lactate-in search of a better prognostic marker in sepsis a cross-sectional study in a rural tertiary care hospital

Background: In intensive care units, sepsis is a common diagnosis. Serum lactate rise has been established as an essential measure for predicting the outcome of sepsis. Higher anion gap(AG) has been associated with an increased risk of death in critically ill individuals. We measured blood lactate levels and AG and looked at how these predicted in-hospital outcomes (death or discharge).This study aimed to estimate anion gap values in sepsis syndrome, to measure the serum lactate levels in sepsis syndrome, to correlate the anion gap and serum lactate values with the outcome (mortality and discharge) in patients with sepsis syndrome. Methods: The Department of Medicine at Jawaharlal Nehru Medical College conducted this single-center, prospective, observational cross-sectional study with a cohort design. A total of 160 patients with sepsis were screened in the ICU. Sepsis was diagnosed using SEPSIS-3 criteria. Results: In this study, we included 160 patients with sepsis with sequential organ failure assessment (SOFA) score >2.Mean serum lactate was 5.1±1.2 mmol/L and it was ≥4 mmol/L in 90% of patients. Mean AG was 14.0±3.9 and it was ≥12 in 75.6% of patients. Similarly, the proportion of patients who had lactate levels ≥4 mmol/L was higher in those with AG ≥12 than AG <12 (95.9% vs. 71.8%, p<0.0001). The AUC of ROC in predicting mortality was significant for both serum lactate (AUC 0.797, p<0.0001) and AG (AUC 0.835, p<0.0001). Conclusions: Along with other parameters predicting mortality, serum lactate and AG also act as important predictors of mortality in sepsis patients. We conclude that on admission serum lactate ≥4 mmol/L and AG ≥12 can be used in predicting short-term mortality in patients with sepsis.

The Study of Lactate/Albumin Ratio as a Predictor of In-Hospital Mortality in Patients with Sepsis and Septic Shock in a Tertiary Care Hospital

Abstract Background: Sepsis is a common and deadly disease that is characterized by elevated levels of acute phase reactants such as high-sensitivity C-reactive protein, lactate dehydrogenase, ferritin, procalcitonin, interleukin (IL-6), tumor necrosis factor, and IL-1. These markers are often used for early diagnosis, management, and risk stratification in patients with septic shock, but they may not be accessible in resource-poor settings with financial constraints. This study aimed to investigate the potential use of the ratio between serum lactate and negative acute phase reactant serum albumin level as a prognostic marker for the outcome of sepsis in resource-poor and -constrained settings. Materials and Methods: The study was a prospective observational study that included 122 patients admitted to the intensive care unit and emergency ward with sepsis or septic shock. Ethical clearance was obtained from the Ethics Committee of Mysore Medical College and Research Institute, and informed consent was obtained from the patients and their attendants. Blood samples for analysis of arterial blood gases, albumin, and other biochemical parameters were collected on the 1st and 3rd days of admission. The outcome of the disease was compared to these parameters using statistical methods such as ANOVA and Chi-square tests with multivariate analysis. Results: The study population consisted of 54.09% males, with one-third of the patients belonging to the age group of 61–70 years. The mortality rate was 27%. The mean serum lactate level on day 1 was 1.7 ± 0.15 mmol/L and on day 3 was 2.65 ± 0.32 mmol/L. The mean serum albumin level on day 1 was 3.14 ± 0.14 g/dL and on day 3 was 3.03 ± 0.13 g/dL. The lactate/albumin ratio on day 1 was 0.49 ± 0.12 and on day 3 was 0.89 ± 0.1 and was positively correlated with the severity of sepsis and septic shock (P < 0.001) and showed a greater significance than lactate or albumin alone. Conclusion: The serum lactate/albumin ratio is a highly sensitive marker that is noninferior to other high-cost biomarkers in assessing the daily prognosis of patients with sepsis in resource-poor and -constrained settings. This study suggests that the lactate/albumin ratio may be a cost-effective, novel, easily feasible, and relevant investigation for assessing the severity and mortality of sepsis and septic shock in rural resource-limited and financially poor hospital settings.

Serum ferritin status and mitochondrial function in children

objective: Iron is the most abundant metal within the mitochondrial matrix . Ferritin reflects bodyironstores. This study aimed to assess the association between serum ferritin levels and mitochondrial function in children. Methods: Two hundred and forty-three children from four governmental primary schools in Mosul city in Iraq were randomly selected by a multistage random sampling method. Their age range was 6-12 years. Mitochondrial function tests involved measurement of serum lactate, serum pyruvate, and L-Carnitine were analyzed in all selected children along with serum ferritin. Results: Lower levels of serum ferritin weresignificantly associated with higher levels of serum lactate, serum lactate/serum pyruvate ratio. There was a significant negative correlation (p = 0.000, - 0.296,- 0.286) between mean serum ferritin level and mean serum lactate, serum lactate / serum pyruvate ratio respectively.There were significant differences (p= 0.000) in mean serum level of mitochondrial function tests (Lactate, L- Carnation, and L/P ratio) in comparing children possessing a normal level of serum ferritin versus those with a low serum ferritin level of < 12 ng/ml. ROC analysis showed that when the area under the curve (AUC) was 0.761 ± SE 0.37, a cut off value 4.79 ng/ml of serum ferritin was significantly (p=0 .000) associated with sensitivity of 100 % and 1- specificity of 0.861 value with presence of L: P molar ratio of ≤ equal 20. Conclusion:Serum ferritin < 12 ng/ ml represntsmitochondrial deficient level. Serum ferritin < 4.79 ng/ml was the critical value at which only 8.6% of children will have a healthy mitochondrial function. Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 374-378

Serum LDH Levels in Normotensive and Preeclamptic-Eclamptic Pregnant Women and Its Correlation With Fetomaternal Outcome.

Background One of the most prevalent medical issues observed during pregnancy is hypertension. Hypertensive disorders of pregnancy (HDP) and their consequences affect around 5-10% of all pregnancies globally. Preeclampsia is caused by endothelial dysfunction, which causes widespread endothelial leakage and contributes to potentially fatal consequences, such as eclampsia, placental abruption, disseminated intravascular coagulation (DIC), severe renal failure, pulmonary edema, and hepatocellular necrosis. As a result, looking for predictive markers for at-risk pregnancies that can suggest poor maternal or fetal outcomes is critical. Elevated levels of lactate dehydrogenase (LDH), as a sign of cellular damage and dysfunction, can be utilized as a biochemical marker in pregnancy-induced hypertension (PIH) as it represents the severity of the disease, and the occurrence of problems, and has also been demonstrated to co-relate with fetomaternal outcomes. Methodology A total of 230 singleton pregnant women of 28-40 weeks of gestational age were enrolled in this study. All women were divided into two groups - normotensive and preeclamptic-eclamptic groups; the second group was further divided intomild preeclampsia, severe preeclampsia, and eclampsia, based on blood pressure and the presence of proteinuria. Serum lactate dehydrogenase levels were measured in both groups and correlated with their fetomaternal outcome. Results Mean serum lactate dehydrogenase (LDH) levelin eclamptic women was 1515.86 ± 754, in severely preeclamptic women was 932.2 ± 448, mild preeclamptic women were 580.5±213, while in normotensive women mean LDH level was 378.6 ± 124. The difference between normotensive and preeclamptic-eclamptic women was statistically significant (p < 0.001). The complications in the preeclamptic-eclamptic group were increased significantly in women with LDH > 800 IU/L, 600-800 IU/L compared to those who had < 600 IU/L LDH levels. Conclusions Serum LDH levels were significantly higher in women of preeclamptic-eclamptic group compared to the normotensive pregnant women. Higher LDH levels were positively correlated with disease severity and maternal complications like placental abruption, hemolysis elevated liver enzymes low platelet count (HELLP), disseminated intravascular coagulation (DIC), acute renal failure, intracranial hemorrhage, pulmonary edema, and maternal death and for fetal complications like preterm, intrauterine growth restriction (IUGR), APGAR at 1 minute < 7, APGAR at 5 minutes < 7, low birth weight (LBW), neonatal intensive care unit (NICU) admission and intrauterine fetal death (IUFD).

Mean Serum Lactate Levels in Patients with Sepsis Presenting to the Department of Emergency Medicine of a Tertiary Care Center: A Descriptive Cross-sectional Study.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Serum lactate is useful in predicting the prognosis of critically ill patients. Elevated blood lactate levels as well as delayed clearance have been linked to higher mortality in sepsis. Shock index is a simple and effective bedside assessment means of gauging the degree of shock and is an important predictor of identifying high-risk patients. Monitoring lactate levels may aid clinicians in understanding tissue perfusion and detecting unrecognized shock and making prompt therapy adjustments. This study aimed to find out the mean serum lactate levels in patients with sepsis presenting to the Department of Emergency Medicine of a tertiary care centre. A descriptive cross-sectional study was conducted at a tertiary care centre among the patient with sepsis presenting to the emergency department from 1 September 2022 to 30 November 2022. Ethical approval was obtained from the Institutional Review Committee of a tertiary care centre (Reference number: 26082022/02). History taking and detailed examination were done. Blood was sent for serum lactate and other parameters as proforma was sent. The shock index was calculated. Convenience sampling was done. Point estimate and 95% confidence interval were calculated. Among 53 sepsis patients, the mean serum lactate level in sepsis patients was 2.84+2.02 (male: 2.83+1.70 and female: 2.85+2.42). The mean serum lactate level in patients with sepsis is similar as compared the studies done in similar settings. emergencies; lactate; sepsis.

A STUDY OF SERUM LACTATE AS A PREDICTOR OF SEVERITY IN DENGUE INFECTION

Background Dengue infections caused by the four antigenically distinct dengue virus serotypes (DENV1, DENV2, DENV3, DENV4) of the family Flaviviridae are the most major arboviral diseases in humans in terms of geographic spread, morbidity, and mortality. Objective serum lactate as a predictor of severity in dengue infection Methodology A prospective observational study was carried out among indoor patients admitted to the general medicine department of the tertiary care hospital SMIMER Surat. The study's duration was 15 to 18 months. Result our study found out of a total of 154 cases, the majority of cases belonged to 83(53.90%) cases were from less than 30 years. the male contributed 96 (62.34%), the majority of cases had a duration of fever 39(25.32%), 66 (42.66%) cases had high LDH, comparison of serum lactate dehydrogenase with the severity of dengue mean lactate dehydrogenase of dengue without severity was mean was 148.45 and SD 11.81, while in severe dengue mean serum lactate dehydrogenase 388.23 and SD 99.47 with p value 0.001 which was statically significant. Conclusion According to this study, it is preferable to monitor serial lactate levels as opposed to using a single lactate number.

Effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients (CONFIDENCE): protocol for a multicentre randomised controlled trial

BackgroundFluid therapy is a common intervention in critically ill patients. It is increasingly recognised that deresuscitation is an essential part of fluid therapy and delayed deresuscitation is associated with longer invasive ventilation and length of intensive care unit (ICU) stay. However, optimal timing and rate of deresuscitation remain unclear. Lung ultrasound (LUS) may be used to identify fluid overload. We hypothesise that daily LUS-guided deresuscitation is superior to deresuscitation without LUS in critically ill patients expected to undergo invasive ventilation for more than 24 h in terms of ventilator free-days and being alive at day 28.MethodsThe “effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients” (CONFIDENCE) is a national, multicentre, open-label, randomised controlled trial (RCT) in adult critically ill patients that are expected to be invasively ventilated for at least 24 h. Patients with conditions that preclude a negative fluid balance or LUS examination are excluded. CONFIDENCE will operate in 10 ICUs in the Netherlands and enrol 1000 patients. After hemodynamic stabilisation, patients assigned to the intervention will receive daily LUS with fluid balance recommendations. Subjects in the control arm are deresuscitated at the physician’s discretion without the use of LUS. The primary endpoint is the number of ventilator-free days and being alive at day 28. Secondary endpoints include the duration of invasive ventilation; 28-day mortality; 90-day mortality; ICU, in hospital and total length of stay; cumulative fluid balance on days 1–7 after randomisation and on days 1–7 after start of LUS examination; mean serum lactate on days 1–7; the incidence of reintubations, chest drain placement, atrial fibrillation, kidney injury (KDIGO stadium ≥ 2) and hypernatremia; the use of invasive hemodynamic monitoring, and chest-X-ray; and quality of life at day 28.DiscussionThe CONFIDENCE trial is the first RCT comparing the effect of LUS-guided deresuscitation to routine care in invasively ventilated ICU patients. If proven effective, LUS-guided deresuscitation could improve outcomes in some of the most vulnerable and resource-intensive patients in a manner that is non-invasive, easy to perform, and well-implementable.Trial registrationClinicalTrials.gov NCT05188092. Registered since January 12, 2022

Microaxial circulatory support for percutaneous coronary intervention: A systematic review and meta-analysis.

Microaxial circulatory support devices have been used to support patients treated with percutaneous coronary intervention (PCI) for acute myocardial infarction complicated by cardiogenic shock (AMICS). The purpose of this systematic review and meta-analysis was to pool and analyze the existing evidence on the baseline characteristics, periprocedural data, and outcomes of microaxial support before and after PCI in AMICS. An electronic database search was performed to identify all cohort studies on Impella and PCI for cardiogenic shock in the English language. A total of five articles comprising 543 patients were included. These patients received microaxial support either before (pre-PCI) or after (post-PCI) undergoing PCI. Comparative analyses were done between both groups. The mean patient age was 66 years [95% Confidence Interval (58-74)], and 22% (89/396) of patients were female. ST-elevation myocardial infarctions (MI)comprised64% (44-80) of MIs and 50% (44-56) of MIs involved the left anterior descending artery. The mean number of diseased vessels was 2.21 (1.62-2.80). The mean left ventricular ejection fraction was 31% (23.4-38.6). The mean arterial pressure was 66.3 mm Hg (54.1-78.5). Mean serum lactate [6.1 mmol/L (3.3-8.9)] and serum creatinine [1.4mg/dl (1.0-1.7)] were similar between groups. 30-day mortality was lower in the pre-PCI group [41% (34%-49%)] compared to the post-PCI group [61% (42%-77%), p< 0.01]. Pooled Kaplan-Meier analysis showed better early survival in the pre-PCI group (p< 0.001). Patients presenting with AMICS were similar at baseline in both pre-PCI and post-PCI groups. Nevertheless, pre-PCI group showed better early survival compared to post-PCI group.

Elevated lactate/albumin ratio as a novel predictor of in-hospital mortality in hospitalized cirrhotics

Introduction and ObjectivesNovel predictors of prognosis in cirrhotic patients have been emerging in recent years and studies show that the lactate/albumin ratio can serve as an early prognostic marker in different patient groups. We aimed to uncover the clinical significance of the lactate/albumin ratio in hospitalized patients with acutely decompensated cirrhosis. Materials and MethodsA retrospective single-center cohort study was conducted in a tertiary medical center. Subjects included had an established diagnosis of liver cirrhosis and were admitted to the ICU or the Internal Medicine department with a clinical picture of acute-on-chronic liver failure between the years 2010 and 2021. The primary outcome was to assess the utility of the lactate/albumin ratio as a prognostic marker to predict mortality in hospitalized cirrhotic patients with acute-on-chronic hepatic failure. ResultsTwo hundred seventy-nine patients were included in this study. Univariate analysis revealed that mean WBC count, platelet/creatinine ratio, aspartate transaminase (AST), lactate, and MELD score were all significantly associated with the primary outcome. Multivariate analysis showed that the lactate/albumin ratio was the strongest statistically significant (p < 0.001) predictor of death during hospitalization - OR 13.196 (95% CI 3.6–48.3), followed by mean WBC count, MELD score, and serum lactate levels. A ROC curve was constructed, which resulted in an area under the curve (AUC) equal to 0.77. Crosstabs from the ROC showed a sensitivity of 66.7% and a specificity of 76.2% when the lactate/albumin ratio chosen as a cutoff was 0.9061 ConclusionsElevated lactate/albumin ratio predicts in-hospital mortality in hospitalized cirrhotics with acute-on-chronic hepatic failure.

Serum and Cerebrospinal Fluid Lactate Dehydrogenase in Children with Febrile Convulsions.

Tissue damage caused by febrile convulsion has not still been proved or refuted completely. Given the fact that lactate dehydrogenase as an intracellular enzyme can be increased due to tissue damage, we decided to evaluate serum and cerebrospinal fluid lactate dehydrogenase in children with febrile convulsion. This is a cross-sectional study on 166 children aged 6-24 month, in three groups of simple febrile convulsion (n=56), complex febrile convulsion (n=27) with 3 different subgroups (recurrence in 24 hours, duration >15 minutes, and with focal components), and control (n=83). Patients' serum and cerebrospinal fluid specimens were collected after meeting the inclusion criteria. Demographic information was documented and patients' serum and cerebrospinal fluid lactate dehydrogenase and glucose were measured. Data were analyzed using SPSS software. The mean serum lactate dehydrogenase in simple febrile convulsion, complex febrile convulsion, and controls were 501.57± 143.70, 553.07±160.22, and 505.87±98.73 U/L, respectively. The mean cerebrospinal fluid lactate dehydrogenase in simple, complex febrile convulsion, and control groups were 22.58±11.92, 29.48±18.18, and 21.56±17.32 U/L, respectively. Only cerebrospinal fluid lactate dehydrogenase difference between complex febrile convulsion and control group (p=0.039) (In the duration >15 minutes subgroup and controls, p=0.028) was statistically significant. There was a significant difference between sex and serum lactate dehydrogenase in thesame subgroup of complex group (p=0.012). Complex febrile convulsion may lead to increase of lactate dehydrogenase in cns of CNS cellular damage.

446. Hyperlactatemia and Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI): Still present even with modern antiretroviral therapy (ART)

Abstract Background Hyperlactatemia and lactic acidosis represent a rare but dangerous manifestation of mitochondrial toxicity associated with NRTIs. Although mitochondrial toxicity has been linked to the NRTI class, it is more prevalent with older agents such as zidovudine (AZT), didanosine (ddI) and stavudine (d4t). Methods Prompted by the diagnosis of symptomatic hyperlactatemia in 4 people with HIV on newer NRTIs between September 2019 and December 2021, we present a single-center case series to illustrate its subtle presentation and management. Hyperlactatemia was defined as a serum lactate of 1.6-4 mmol/L and lactic acidosis was defined as a serum lactate of &amp;gt; 4mmol/L. Results 75% of the patients were male, the mean age was 57.8 years, and 100% were Caucasian. 75% (3/4) were either overweight or obese (body mass index &amp;gt; 25 kg/m2). 75% had a CD4 lymphocyte count &amp;lt; 200 cells/mm3 at the time of human immunodeficiency virus (HIV) diagnosis and 50% had the diagnosis for &amp;gt;10 years. The most common symptom reported was non-specific fatigue (100%), followed by widespread myalgias (75%). 1 patient reported severe peripheral neuropathy affecting activities of daily living and 1 patient reported palpitations and night sweats. The mean duration of symptoms prior to reporting was 27.5 months. At the time of diagnosis of symptomatic hyperlactatemia, 75% had a CD4 lymphocyte count &amp;gt; 200 cells/mm3, the mean serum lactate was 2.7 mmol/L (1.9 mmol/L - 3.9 mmol/L), 50% were on abacavir (ABC) and lamivudine (3TC), and 50% were on tenofovir alafenamide (TAF) and emtricitabine (FTC). After stopping ART for 2 weeks, mean serum lactate decreased to 0.6 mmol/L (0.4 mmol/L – 1.1 mmol/L). 100% reported an improvement in quality of life after NRTI cessation and were managed with an NRTI-sparing regimen. Clinical characteristics are noted in Table 1. Conclusion This case series highlights the insidious nature of symptoms related to NRTI-associated mitochondrial toxicity including hyperlactatemia. Management strategies are not well defined for hyperlactatemia; however, NRTI-sparing regimens may offer improvement in quality of life. Despite improved tolerability of modern ART, clinicians should be aware of and monitor for symptoms of this potentially life-threatening side effect. Disclosures Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healthcare: Advisor/Consultant.

DETERMINANTS INFLUENCING LENGTH OF ICU STAY IN RENAL TRANSPLANT RECIPIENTS UNDERGOING GENERAL ANAESTHESIA

Background: In this study, we wantedto evaluate the duration of intensive care unit (ICU) stay in renal transplant recipients and identify the perioperative factors affecting the duration of ICU stay. Materials And Methods: This was a hospital basedprospective cohort study conducted among 76 patients who presented with renal transplantationto the Department ofAnaesthesiology and Intensive Care Unit, Max Super Speciality Hospital, Mohali of Punjab State, from May 2018 toApril 2019after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: Longer ICU stay was associated with pleural effusion and left ventricular hypokinesia(p value &lt;0.05). No significant association was found between other clinical conditions and duration of ICU stay.Longer ICU stay was associated if duration of dialysis is longer and thrice a week dialysis. This was statistically significant (p value &lt;0.05).Higher mean serum lactate levels were associated with longer ICU stay (p value &lt;0.05).Longer ICU stay was found in those who had lower mean arterial pressure, higher systolic blood pressure and lower urine output. This was found to be statistically significant. Longer ICU stay was associated with low blood pH, higher serum lactate and lower urine output during post-operative period. This was found to be significant Conclusion:There were certain factors which affected the duration of ICU stay – Older age, higher ASA grades, longer duration of dialysis, and higher frequency of dialysis.Among the perioperative parameters- preoperative mean serum lactate levels, intraoperative lower mean arterial pressure, lower systolic blood pressure and lower urine output, post-operative low blood pH, higher serum lactate and lower urine output were associated with longer duration of ICU stay.

The Association Between Serum Lactate Concentration, Base Deficit, and Mortality in Polytrauma Patients as a Prognostic Factor: An Observational Study.

IntroductionIn polytrauma patients, it is crucial to identify the severity of the injuries to ensure patient safety and survival. Polytrauma leads to hypotension and hypoperfusion, which results in an anaerobic metabolism with acidosis and a decrease in base excess. Thus, blood lactate levels above a certain threshold indicate the existence of global tissue hypoxia, which is a precursor to shock and multiple organ dysfunction syndrome (MODS). The serum lactate and base deficit (BD) levels are used in polytrauma patients as measures of damage severity and resuscitation endpoints and as a way to evaluate therapy efficacy and to predict outcomes. Thus, arterial blood gas analysis is of great value in assessing the status and prognosis of patients with polytrauma. There are few comparative studies on the predictive values of these markers in trauma patients. To determine which measure can more accurately predict the prognosis of polytrauma patients, the present study investigated the predictive values of mortality of these indicators for mortality within 48 hours of admission to the emergency room (ER) in patients with polytrauma.MethodsThis prospective study was designed for a single tertiary care center in northern India. We included 90 patients with polytrauma who were between the ages of 18 and 70 years, with the exception of pregnant women, who presented to the ER within six hours of injury with an injury severity score (ISS) >16, serum lactate level >2.0 mmol/L, and BD -4.0 mEq/L at the time of admission. If the patient's ISS was >16 at the time of ER presentation, arterial blood samples were drawn to determine the serum lactate and BD level at the time of admission and at 12, 24, and 48 hours intervals after ER admission. The primary outcome was the change in serum lactate and BD level in polytrauma. The secondary outcomes were an association of serum lactate and BD with mortality and the correlation between serum lactate with the BD and ISS with mortality of polytrauma patients. The timing of all outcome assessments was at 48 hours after each patient's ER admission.ResultsLactate clearance from 0-12 hours (t = 2.28, p <0.05), 0-24 hours (t = 6.01, p <0.001), and 0-48 hours (t = 7.98, p <0.001) and a correction in BD from 0-24 (t = 2.68, p <0.01 ) and 0-48 hours (t = 5.46, p <0.001) were significantly higher in nonsurvivors as compared with survivors. In survivors and nonsurvivors, mean serum lactate levels (2.46 ± 1.46 versus 4.15 ± 2.99, t = 3.31, p <0.001, 95%Cl) and mean BD (-3.17 ± 2.58 versus -6.5 ± 4.91, t = 3.86, p <0.001, 95%CI) had a statistically significant difference. The serum lactate and BD levels at time of ER admission (r L0, BD0 = -0.765, p <0.01) and 48 hours after ER admission (r L48, BD 48 = -0.652, p <0.001) were highly negatively correlated.ConclusionIn polytrauma patients, serum lactate and BD are simple, quick, and independent biochemical predictors of 48-hour mortality, and this single arterial blood test would thereby improve decision-making for resuscitation effectiveness. Prolonged lactate and BD normalization time were associated with higher mortality. Serum lactate and BD are negatively correlated. A higher ISS at admission was associated with a higher incidence of mortality in polytrauma patients.

Advanced Triage Protocol: The Role of an Automated Lactate Order in Expediting Rapid Identification of Patients at Risk of Sepsis in the Emergency Department.

OBJECTIVES:We undertook a process improvement initiative to expedite rapid identification of potential sepsis patients based on triage chief complaint, vital signs, and initial lactate level.DESIGN:Prospective cohort study.SETTING:Seven hundred-bed tertiary care hospital with ≅65,000 patient visits/yr.PATIENTS:Patients presenting to emergency department (ED) triage who met the following criteria: greater than or equal to two of the three systemic inflammatory response syndrome criteria assessable in triage, a chief complaint suggestive of infection, emergency severity index 2 or 3, and ambulatory to ED.INTERVENTIONS:A computer-generated lactate order was created, staff education and resources increased, and point-of-care lactate testing was introduced.MEASUREMENTS AND MAIN RESULTS:Primary endpoints include the following: percent of patients having a lactate level drawn, percent of lactate samples resulting before room placement, and time intervals from triage to lactate blood draw and to lactate result. Secondary endpoints were percentage of patients admitted to the hospital, percentage admitted to the ICU, and in-hospital mortality. Six thousand nine hundred six patients were included: 226 historic controls (HCs) and 6,680 intervention group patients. The mean serum lactate level was 1.77 ± 1.18 mmol/L. The percentage of patients having a lactate resulted increased from 27.4% in the HC period to 79.6%. The percentage of these lactate results available while the patient was still in the waiting room increased from 0.4% during the HC period to 33.7% during Phase 5 (p < 0.0001). In the intervention period, time from triage to lactate result decreased (78.1–63.4 min; p < 0.0001) and time to treatment room decreased (59.3–39.6 min; p < 0.0001).CONCLUSIONS:Implementation of a computerized lactate order using readily available data obtained during ED triage, combined with point-of-care lactate testing, improves time to lactate blood draw and lactate result in patients at risk for severe sepsis. Initial lactate levels correlated with admission to the hospital, admission to the ICU, and in-hospital mortality.

Outcomes and Factors Associated with Occult Septic Shock in Emergency Department Patients with Soft Tissue Infection

Patients who develop occult septic shock (OSS) are associated with worse outcomes than those with early septic shock (ESS). Patients with skin and soft tissue infection (SSTI) may have underlying organ dysfunction due to OSS, yet the prevalence and the outcomes of patients with SSTI and early versus occult shock have not been described. This study compared the clinical characteristics of SSTI patients and the prevalence of having no septic shock (NSS), ESS, or OSS. We retrospectively analyzed charts of adult patients who were transferred from any emergency department to our academic center between January 1, 2014, and December 31, 2016. Outcomes of interest were the development of OSS and acute kidney injury (AKI). We performed logistic regressions to measure the association between clinical factors with the outcomes and created probability plots to show the relationship between key clinical variables and outcomes of OSS or AKI. Among 269 patients, 218 (81%) patients had NSS, 16 (6%) patients had ESS, and 35 (13%) patients had OSS. Patients with OSS had higher mean serum lactate concentrations than patients with NSS (3.5 vs. 2.1 mmol/L, P < 0.01). Higher sequential organ failure assessment (SOFA) score was associated with higher likelihood of developing OSS (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.23-1.62, P < 0.001). NSS was associated with very low odds of developing AKI (OR 0.16, 95% CI 0.08-0.33, P < 0.001). 13% of the patients with SSTI developed OSS. Patients with OSS had elevated serum lactate concentration and higher SOFA score than those with NSS. Increased SOFA score is a predictor for the development of OSS.

Clinical Features of Children with COVID-19 Infection: Single-Center Experience.

Compared to adult studies, there are few epidemiological and clinical reports on coronavirus disease 2019 in children. We aimed to present the demographic, epidemiological, and clinical findings of hospitalized pediatric coronavirus disease 2019 patients. Patients aged 0-18 years who were hospitalized between March and July 2020 due to severe acute respiratory syndrome coronavirus 2 infection were evaluated retrospectively. The mean age was 90.2 ± 67.5 (7-24) months and 23 (51%) were female. Clinical presentation was asymptomatic in 15 cases (33.3%), mild/moderate in 26 cases (57.8%), and severe/critical in 4 cases (8.9%). Three (6.6%) of the patients had chronic medical conditions that placed them in the high-risk group for coronavirus disease 2019. The source of infection was household transmission in 29 cases (64.4%). The most common symptoms were cough, fever, and fatigue. Mean serum lactate, C-reactive protein (CRP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were significantly higher in severe/criti- cal patients compared to the other two groups (P < .05). severe acute respiratory syndrome coronavirus 2 negativity in control swabs (n=26) occurred at a mean of 10.6 ± 2.9 days after symptom onset. Forty-three patients (95.6%) were followed in the ward and 2 (4.4%) were admitted to the intensive care unit. Children aged 0-18 years constituted a very small proportion of coronavirus disease 2019 reverse transcription-polymerase chain reaction -positive cases. Asymptomatic carriage of SARS- CoV-2 by a large proportion of children seems to be a major factor driving community spread. Some children with coronavirus disease 2019 may also present neurological findings. coronavirus disease 2019 infection is more severe in patients with comorbidities, and support therapy is important in these patients.