Rapid decrease in plasma D-lactate as an early potential predictor of diminished 28-day mortality in critically ill...

Area of Science:

• Critical Care Medicine
• Biochemistry
• Sepsis Pathophysiology

Background:

• Splanchnic ischemia is a key factor in organ failure during septic shock.
• Plasma D-lactate is considered a more sensitive indicator of splanchnic hypoperfusion than L-lactate.
• This study investigates the prognostic value of plasma D- and L-lactate levels in septic shock.

Purpose of the Study:

• To evaluate the prognostic accuracy of plasma D-lactate and L-lactate levels in patients with septic shock.
• To compare the predictive capabilities of D-lactate versus L-lactate for 28-day mortality.

Main Methods:

• A prospective study was conducted in an intensive care unit involving patients diagnosed with septic shock.
• Plasma samples for D- and L-lactate measurement were collected twice: within 6 hours of meeting septic shock criteria (day 1) and 24 hours later (day 2).

Main Results:

• Both day 1 plasma D- and L-lactate levels were associated with 28-day mortality.
• Plasma L-lactate showed a higher area under the receiver operating characteristic curve (0.84 on day 1, 0.90 on day 2) compared to D-lactate (0.68 on day 1, 0.74 on day 2).
• In survivors, D-lactate levels decreased significantly from day 1 to day 2, while L-lactate levels did not show a significant change.

Conclusions:

• Plasma D- and L-lactate levels effectively differentiate between survivors and non-survivors in septic shock.
• The prognostic performance of plasma L-lactate was superior to that of plasma D-lactate.
• A rapid decline in plasma D-lactate during septic shock may signal a lower risk of 28-day mortality.