Acute Crit Care.  2022 Feb;37(1):108-117. 10.4266/acc.2021.00332.

Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock

• Tongyoo S
• Sutthipool K
• Viarasilpa T
• Permpikul C

• KMID: 2527913
• DOI: http://doi.org/10.4266/acc.2021.00332

Abstract

Background
In septic shock patients with cirrhosis, impaired liver function might decrease lactate elimination and produce a higher lactate level. This study investigated differences in initial lactate, lactate clearance, and lactate utility between cirrhotic and non-cirrhotic septic shock patients.
Methods
This is a retrospective cohort study conducted at a referral, university-affiliated medical center. We enrolled adults admitted during 2012–2018 who satisfied the septic shock diagnostic criteria of the Surviving Sepsis Campaign: 2012. Patients previously diagnosed with cirrhosis by an imaging modality were classified into the cirrhosis group. The initial lactate levels and levels 6 hours after resuscitation were measured and used to calculate lactate clearance. We compared initial lactate, lactate at 6 hours, and lactate clearance between the cirrhosis and non-cirrhosis groups. The primary outcome was in-hospital mortality.
Results
Overall 777 patients were enrolled, of whom 91 had previously been diagnosed with cirrhosis. Initial lactate and lactate at 6 hours were both significantly higher in cirrhosis patients, but there was no difference between the groups in lactate clearance. A receiver operating characteristic curve analysis for predictors of in-hospital mortality revealed cut-off values for initial lactate, lactate at 6 hours, and lactate clearance of >4 mmol/L, >2 mmol/L, and <10%, respectively, among non-cirrhosis patients. Among patients with cirrhosis, the cut-off values predicting in-hospital mortality were >5 mmol/L, >5 mmol/L, and <20%, respectively. Neither lactate level nor lactate clearance was an independent risk factor for in-hospital mortality among cirrhotic and non-cirrhotic septic shock patients.
Conclusions
The initial lactate level and lactate at 6 hours were significantly higher in cirrhosis patients than in non-cirrhosis patients.

Keyword

cirrhosis; lactate clearance; mortality; prediction; septic shock; serum lactate level

Figure

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  Figure 1. Receiver operative characteristic (ROC) curve analysis to identify the serum lactate level cut-off value predicting in-hospital mortality. (A) ROC curve for non-cirrhosis patients. (B) ROC curve for cirrhosis patients. AUC: area under the ROC curve; CI: confidence interval.

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