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Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a
Namkje A R Vellinga1,2, E Christiaan Boerma3, Matty Koopmans3
1Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands. namkjevellinga@hotmail.com.
Critical Care (London, England)
|October 20, 2017
Summary
Mildly elevated lactate levels in critically ill patients are linked to poor outcomes and microcirculatory dysfunction. Bedside microscopy can help differentiate causes of elevated lactate, aiding in patient prognostication.
Area of Science:
- Critical Care Medicine
- Physiology
- Diagnostic Imaging
Background:
- Mildly elevated lactate levels (1-2 mmol/L) are increasingly recognized as prognostic indicators in critically ill patients.
- Microcirculatory dysfunction is a potential mechanism underlying elevated lactate and can be assessed using bedside microscopy.
Purpose of the Study:
- To evaluate the association between mild hyperlactatemia, microcirculatory flow, and patient outcomes.
- To determine if bedside in vivo microscopy can differentiate causes of elevated lactate.
Main Methods:
- A predefined subanalysis of the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP) study.
- Assessment of microcirculatory flow using sidestream dark-field imaging and calculation of the microvascular flow index (MFI).
- Analysis of associations between lactate levels, MFI, and ICU mortality in 257 patients with lactate ≤ 2 mmol/L.
Main Results:
- Crude ICU mortality increased with higher lactate quartiles.
- A lactate level > 1.5 mmol/L was independently associated with abnormal microcirculatory flow (MFI < 2.6) (OR 2.5, P=0.027).
Conclusions:
- Mildly elevated lactate levels, even within the reference range, are independently associated with increased mortality and microvascular flow abnormalities in ICUs.
- In vivo microscopy may aid in distinguishing flow-related from non-flow-related causes of mildly elevated lactate.
