Abstract
Background The prediction of prognosis is an important part of management in decompensated cirrhosis (DeCi) patients with high long-term mortality. Lactate is a known predictor of outcome in critically ill patients. The aim of this study was to assess the prognostic value of lactate in DeCi patients.Methods We performed a single-center, observational, retrospective study of 456 DeCi patients extracted from hospitalization. Univariate and multivariate analyses were used to determine whether lactate was independently associated with the prognosis of DeCi patients. The AUROC was calculated to assess the predictive accuracy compared with existing scores.Results Serum lactate level was significantly higher in nonsurviving patients than in surviving patients. Univariate and multivariate analyses demonstrated that lactate was a risk-independent factor 6-months mortality (odds ratio: 1.412, P=0.001). ROC curves were drawn to evaluate the prediction efficiencies of lactate for 6-months mortality (AUROC: 0.716, P<0.001). Based on our patient cohort, the new scores (MELD+ lactate score, Child-Pugh+ lactate score) had good accuracy for predicting 6-months mortality (AUROC=0.769, P<0.001; AUROC= 0.766, P<0.001). Additionally, the performance of the new scores was superior to those of existing scores (all P < 0.001).Conclusion Serum lactate at admission may be useful for predicting 6-months mortality in DeCi patients, and the predictive value of the MELD score and Child-Pugh score were improved by adjusting lactate. Lactate should be part of the rapid diagnosis and initiation of therapy to improve clinical outcome.
Metabolic acid-base status in critically ill patients: is standard base excess correlated with serum lactate level?
