Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis

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dc.contributor.authorVellinga, Namkje A. R.
dc.contributor.authorRuiz, Carolina.
dc.contributor.authorBoerma, E. C.
dc.contributor.authorKoopmans, Matty.
dc.contributor.authorDonati, Abele.
dc.contributor.authorDubin, Arnaldo.
dc.contributor.authorShapiro, Nathan I.
dc.contributor.authorPearse, Rupert M.
dc.contributor.authorvan der Voort, Peter H. J.
dc.contributor.authorDondorp, Arjen M.
dc.date.accessioned2019-10-17T15:01:11Z
dc.date.available2019-10-17T15:01:11Z
dc.date.issued2017
dc.date.updated2019-10-14T19:05:32Z
dc.description.abstractAbstract Background Mildly elevated lactate levels (i.e., 1–2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to evaluate the association between relative hyperlactatemia, microcirculatory flow, and outcome. Methods This study was a predefined subanalysis of a multicenter international point prevalence study on microcirculatory flow abnormalities, the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Microcirculatory flow abnormalities were assessed with sidestream dark-field imaging. Abnormal microcirculatory flow was defined as a microvascular flow index (MFI) < 2.6. MFI is a semiquantitative score ranging from 0 (no flow) to 3 (continuous flow). Associations between microcirculatory flow abnormalities, single-spot lactate measurements, and outcome were analyzed. Results In 338 of 501 patients, lactate levels were available. For this substudy, all 257 patients with lactate levels ≤ 2 mmol/L (median [IQR] 1.04 [0.80–1.40] mmol/L) were included. Crude ICU mortality increased with each lactate quartile. In a multivariable analysis, a lactate level > 1.5 mmol/L was independently associated with a MFI < 2.6 (OR 2.5, 95% CI 1.1–5.7, P = 0.027). Conclusions In a heterogeneous ICU population, a single-spot mildly elevated lactate level (even within the reference range) was independently associated with increased mortality and microvascular flow abnormalities. In vivo microscopy of the microcirculation may be helpful in discriminating between flow- and non-flow-related causes of mildly elevated lactate levels. Trial registration ClinicalTrials.gov, NCT01179243 . Registered on August 3, 2010.
dc.fuente.origenBiomed Central
dc.identifier.citationCritical Care. 2017 Oct 18;21(1):255
dc.identifier.doi10.1186/s13054-017-1842-7
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/26738
dc.identifier.urihttps://doi.org/10.1186/s13054-017-1842-7
dc.identifier.wosidWOS:000413122500001
dc.issue.numeroNo. 255
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final9
dc.pagina.inicio1
dc.revistaCritical Carees_ES
dc.rightsacceso abierto
dc.rights.holderThe Author(s).
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.subject.otherLactatoes_ES
dc.subject.otherCuidados intensivoses_ES
dc.subject.otherMicrocirculaciónes_ES
dc.titleMildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysises_ES
dc.typeartículo
dc.volumenVol. 21
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