Liver cirrhosis affects serum lactate level measurement while assessing disease severity in patients with sepsis
Abstract Background Elevated serum lactate is associated with higher mortality in sepsis, whereas liver dysfunction is associated with higher serum lactate levels. We assessed the predictive ability of serum lactate in patients with liver cirrhosis and sepsis. Methods This retrospective study included 12,281 cases of suspected infection with initial serum blood lactate drawn during January 2007-December 2013. Results Using one-to-two propensity score matching analysis, 1,053 and 2,106 septic patients with and without underlying liver cirrhosis, respectively, were successfully matched. Lactate levels of survivors and non-survivors were 2.58 and 5.93 mmol/L, respectively, in patients without liver cirrhosis (WLC), 2.96 and 7.29 mmol/L, respectively, in patients with non-decompensated liver cirrhosis (NDLC), and 4.08 and 7.1 6 mmol/L, respectively, in patients with decompensated liver cirrhosis (DLC). Adjusted odds ratios of an initial serum lactate level >2 mmol/L in 28-day in-hospital mortality were 4.99, 4.74, and 3.33 in the WLC, NDLC, and DLC groups, respectively. In receiver operating characteristic curve analysis, the sensitivity and specificity for predicting mortality were 0.81 and 0.55, respectively, in the WLC group, 0.85 and 0.45, respectively, in the NDLC group, and 0.86 and 0.33, respectively, in the DLC group, using serum lactate levels >2.0 mmol/L. Conclusions Serum lactate level can be used to predict the severity of sepsis in patients with liver cirrhosis; however, its specificity would be lower at a cutoff of 2.0 mmol/L.