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Understanding lactatemia in human sepsis potential impact for early management

Gattinoni, L., Vasques, F., Camporota, L., Meessen, J., Romitti, F., Pasticci, I., Duscio, E., Vassalli, F., Forni, Lui G., Payen, D. , Cressoni, M., Zanella, A., Latini, R., Quintel, M. and Marini, J.J. (2019) Understanding lactatemia in human sepsis potential impact for early management American Journal of Respiratory and Critical Care Medicine, 200 (5). pp. 582-589.

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Rationale: Hyperlactatemia in sepsis may derive from a prevalent impairment of oxygen supply/demand and/or oxygen use. Discriminating between these two mechanisms may be relevant for the early fluid resuscitation strategy. Objectives: To understand the relationship among central venous oxygen saturation (ScvO2), lactate, and base excess to better determine the origin of lactate. Methods: This was a post hoc analysis of baseline variables of 1,741 patients with sepsis enrolled in the multicenter trial ALBIOS (Albumin Italian Outcome Sepsis). Variables were analyzed as a function of sextiles of lactate concentration and sextiles of ScvO2. We defined the “alactic base excess,” as the sum of lactate and standard base excess. Measurements and Main Results: Organ dysfunction severity scores, physiologic variables of hepatic, metabolic, cardiac, and renal function, and 90-day mortality were measured. ScvO2 was lower than 70% only in 35% of patients. Mortality, organ dysfunction scores, and lactate were highest in the first and sixth sextiles of ScvO2. Although lactate level related strongly to mortality, it was associated with acidemia only when kidney function was impaired (creatinine >2 mg/dl), as rapidly detected by a negative alactic base excess. In contrast, positive values of alactic base excess were associated with a relative reduction of fluid balance. Conclusions: Hyperlactatemia is powerfully correlated with severity of sepsis and, in established sepsis, is caused more frequently by impaired tissue oxygen use, rather than by impaired oxygen transport. Concomitant acidemia was only observed in the presence of renal dysfunction, as rapidly detected by alactic base excess. The current strategy of fluid resuscitation could be modified according to the origin of excess lactate.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
Gattinoni, L.
Vasques, F.
Camporota, L.
Meessen, J.
Romitti, F.
Pasticci, I.
Duscio, E.
Vassalli, F.
Forni, Lui
Payen, D.
Cressoni, M.
Zanella, A.
Latini, R.
Quintel, M.
Marini, J.J.
Date : 1 September 2019
DOI : 10.1164/rccm.201812-2342OC
Copyright Disclaimer : Copyright © 2019 by the American Thoracic Society
Uncontrolled Keywords : Sepsis; Lactic acidosis; Venous oxygen saturation; Base excess
Depositing User : Diane Maxfield
Date Deposited : 28 Oct 2019 16:06
Last Modified : 28 Oct 2019 16:06

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