scholarly journals Alteration of Blood Lactate Levels in Severe Falciparum Malaria: A Systematic Review and Meta-Analysis

Biology ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1085
Author(s):  
Polrat Wilairatana ◽  
Wanida Mala ◽  
Manas Kotepui ◽  
Kwuntida Uthaisar Kotepui
Keyword(s):  
Severe Malaria ◽  
Blood Lactate ◽  
Lactate Level ◽  
Uncomplicated Malaria ◽  
Weighted Mean Difference ◽  
Blood Lactate Level ◽  
Mean Difference ◽  
The Mean ◽  
Lactate Levels ◽  
Blood Lactate Levels

Metabolic acidosis in severe malaria usually occurs in the form of lactic acidosis. The present study aimed to collate articles from the literature that have reported blood lactate levels in patients with severe malaria and tested the hypothesis that blood lactate levels are elevated in patients with malaria compared to those with uncomplicated malaria. Moreover, the difference in lactate levels between patients who died and those who survived was estimated using a meta-analytic approach. Potentially relevant studies were searched for in PubMed, Web of Science, and Scopus. The quality of the included studies was assessed using the Jadad scale and strengthening the reporting of observational studies in epidemiology (STROBE). The pooled mean blood lactate in patients with severe malaria, the pooled weighted mean difference (WMD) of blood lactate between patients with severe malaria and those with uncomplicated malaria, and the pooled WMD and 95% CI of blood lactate between patients who died from and those who survived severe malaria were estimated using the random-effects model. Heterogeneity among the outcomes of the included studies was assessed using Cochran’s Q and I2 statistics. A meta-regression analysis was performed to identify the source(s) of heterogeneity of outcomes among the included studies. A subgroup analysis was further performed to separately analyze the outcomes stratified by the probable source(s) of heterogeneity. Publication bias was assessed by the visual inspection of the funnel plot asymmetry. Of 793 studies retrieved from the searches, 30 studies were included in qualitative and quantitative syntheses. The pooled mean lactate in patients with severe malaria was 5.04 mM (95% CI: 4.44–5.64; I2: 99.9%; n = 30,202 cases from 30 studies). The mean lactate in patients with severe malaria (1568 cases) was higher than in those with uncomplicated malaria (1693 cases) (p = 0.003; MD: 2.46; 95% CI: 0.85–4.07; I2: 100%; nine studies). The mean lactate in patients with severe malaria who died (272 cases) was higher than in those with severe malaria who survived (1370 cases) (p < 0.001; MD: 2.74; 95% CI: 1.74–3.75; I2: 95.8%; six studies). In conclusion, the present study showed a high mean difference in blood lactate level between patients with severe malaria and patients with uncomplicated malaria. In addition, there was a high mean difference in blood lactate level between patients with severe malaria who died compared to those with severe malaria who survived. Further studies are needed to investigate the prognostic value of blood lactate levels to identify patients who are at high risk of developing severe malaria or dying.

scholarly journals Prehospital lactate improves prediction of the need for immediate interventions for hemorrhage after trauma

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Hiroshi Fukuma ◽  
Taka-aki Nakada ◽  
Tadanaga Shimada ◽  
Takashi Shimazui ◽  
Tuerxun Aizimu ◽  
...  
Keyword(s):  
Blood Lactate ◽  
Lactate Level ◽  
Area Under The Curve ◽  
Blood Lactate Level ◽  
Trauma Patients ◽  
Circulatory Disturbance ◽  
Physiological Variables ◽  
Level I ◽  
Lactate Levels ◽  
Blood Lactate Levels

Abstract The blood lactate level is used to guide the management of trauma patients with circulatory disturbance. We hypothesized that blood lactate levels at the scene (Lac scene) could improve the prediction for immediate interventions for hemorrhage. We prospectively measured blood lactate levels and assessed retrospectively in 435 trauma patients both at the scene and on arrival at the emergency room (ER) of a level I trauma center. Primary outcome was immediate intervention for hemorrhage defined as surgical/radiological intervention and/or blood transfusion within 24 h. Physiological variables plus Lac scene significantly increased the predictive value for immediate intervention (area under the curve [AUC] 0.882, 95% confidence interval [CI] 0.839–0.925) compared to that using physiological variables only (AUC 0.837, 95% CI 0.787–0.887, P = 0.0073), replicated in the validation cohort (n = 85). There was no significant improvement in predicting value of physiological variables plus Lac scene for massive transfusion compared to physiological variables (AUC 0.903 vs 0.895, P = 0.32). The increased blood lactate level per minute from scene to ER was associated with increased probability for immediate intervention (P < 0.0001). Both adding Lac scene to physiological variables and the temporal elevation of blood lactate levels from scene to ER could improve the prediction of the immediate intervention.

scholarly journals Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3290
Author(s):  
Romain Jouffroy ◽  
Teddy Léguillier ◽  
Basile Gilbert ◽  
Jean Pierre Tourtier ◽  
Emmanuel Bloch-Laine ◽  
...  
Keyword(s):  
Septic Shock ◽  
Blood Lactate ◽  
Disease Severity ◽  
Lactate Level ◽  
Cox Regression ◽  
Blood Lactate Level ◽  
Controlled Study ◽  
Cox Regression Analysis ◽  
Lactate Levels ◽  
Blood Lactate Levels

Background: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, the clinical picture alone is not sufficient for assessing disease severity and outcomes. Because blood lactate level is included in the clinical criteria of SS it should be considered to improve the assessment of its severity. This study aims to investigate the relationship between pre-hospital blood lactate level and 30-day mortality in patients with SS. Methods: From 15 April 2017 to 15 April 2019, patients with SS requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were prospectively included in the LAPHSUS study, an observational, non-randomized controlled study. Pre-hospital blood lactate levels were measured at the time of first contact between the patients and the MICU. Results: Among the 183 patients with septic shock requiring action by the MICU drawn at random from LAPHSUS study patients, six (3%) were lost to follow-up on the 30th day and thus 177 (97%) were analyzed for blood lactate levels (mean age 70 ± 14 years). Pulmonary, urinary and digestive infections were probably the cause of the SS in respectively 58%, 21% and 11% of the cases. The 30-day overall mortality was 32%. Mean pre-hospital lactatemia was significantly different between patients who died and those who survived (respectively 7.1 ± 4.0 mmol/L vs. 5.9 ± 3.5 mmol/L, p < 10−3). Using Cox regression analysis adjusted for potential confounders we showed that a pre-hospital blood lactate level ≥ 4 mmol/L significantly predicted 30-day mortality in patients with SS (adjusted hazard ratio = 2.37, 95%CI (1.01–5.57), p = 0.04). Conclusion: In this study, we showed that pre-hospital lactatemia predicts 30-day mortality in patients with septic shock handled by the MICU. Further studies will be needed to evaluate if pre-hospital lactatemia alone or combined with clinical scores could affect the triage decision-making process for those patients.

scholarly journals Intraoperative changes in blood lactate levels are associated with worse short-term outcomes after cardiac surgery with cardiopulmonary bypass

Perfusion ◽  
2019 ◽  
Vol 34 (8) ◽  
pp. 640-650 ◽  
Author(s):  
Benoit Duval ◽  
Thibaud Besnard ◽  
Stefano Mion ◽  
Sébastien Leuillet ◽  
Olivier Jecker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Blood Lactate ◽  
Lactate Level ◽  
Blood Lactate Level ◽  
Short Term ◽  
Laboratory Test Results ◽  
Lactate Levels ◽  
Blood Lactate Levels

Background: A high perioperative blood lactate level has been reported to be associated with poor outcomes after cardiac surgery. More than isolated peaks of lactate values, it should be more interesting to take into account changes in intraoperative blood lactate level (∆Lact). This large-scale retrospective study evaluated the relationship between ∆Lact and overall intensive care unit morbidity and 30-day all-cause mortality. Methods: Perioperative data from consecutive patients undergoing on-pump cardiac surgery between September 2010 and June 2016 were retrospectively analysed through our institutional database including clinical, transfusion and laboratory test results implemented prospectively by physicians. Blood lactate levels were initially measured after induction of anaesthesia (baseline) and periodically during the surgery. The ∆Lact was defined as the difference between the highest intraoperative blood lactate and the baseline lactate level and offered the opportunity to stratify patients into four subgroups: ⩽0, 0.1-0.9, 1-1.9 and ⩾2 mmol L−1. Results: From the 7,795 patients found eligible during the study period, 7,447 patients were analysed. The median ∆Lact of our patients was 0.6 (0.3-1) mmol L−1. Most of the studied patients (65.9%) exhibited a ∆Lact between 0.1 and 0.9 mmol L−1. A concentration-dependent relationship was observed between ∆Lact and intensive care unit morbidity and 30-day mortality. After adjustment for co-variables, all ∆Lact > 0 was associated with an increase in overall intensive care unit morbidity. An independent relationship was also found between ∆Lact and 30-day mortality as of a 1 mmol L−1 increase. Conclusion: Our results suggest that ∆Lact is associated with poor short-term outcomes in adult cardiac surgical patients.

scholarly journals Target blood pressure management during cardiopulmonary bypass improves lactate levels after cardiac surgery: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qing Miao ◽  
Dong Jin Wu ◽  
Xu Chen ◽  
Meiying Xu ◽  
Lin Sun ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Blood Lactate ◽  
Lactate Level ◽  
Operation Time ◽  
Blood Lactate Level ◽  
Pressure Management ◽  
Lactate Levels ◽  
Group Target ◽  
Blood Lactate Levels

Abstract Background Hyperlactatemia is associated with a poor prognosis in cardiac surgery patients. This study explored the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate levels after cardiac surgery. Methods Adult patients undergoing cardiac valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital were enrolled. The patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n = 20 for each. Norepinephrine was titrated only during CPB to maintain MAP at the target level. Blood lactate levels in the two groups were detected before the operation (T0), at the end of CPB (T1), at the end of the operation (T2), 1 h after the operation (T3), 6 h after the operation (T4) and 24 h after the operation (T5). The primary outcome was the blood lactate level at the end of the operation (T2). The secondary outcomes included the blood lactate level at T1, T3, T4, and T5 and the dose of epinephrine and dopamine within 24 h after the operation, time to extubation, length of stay in the ICU, incidence of readmission within 30 days, and mortality within 1 year. Results Forty patents were enrolled and analyzed in the study. The lactate level in the H-MAP group was significantly lower than that in the L-MAP group at the end of the operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at the end of CPB and 1 hour after surgery. The dose of epinephrine within 24 h after the operation, time to extubation and length of stay in the ICU in the L-MAP group were significantly higher than those in the H-MAP group. Conclusions Maintaining a relatively higher MAP during CPB deceased the blood lactate level at the end of surgery, reduced epinephrine consumption, and shortened the time to extubation and length of stay in the ICU after surgery. Trial registration This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 8/1/2020 with the registration number ChiCTR2000028941. It was conducted from 20/1/2020 to 30/6/2020 as a single, blinded trial in Shanghai Chest Hospital.

scholarly journals Pengaruh ekspresi p53 dan HIF1 terhadap peningkatan laktat jaringan nasofaring pada pasien karsinoma nasofaring

2018 ◽  
Vol 48 (1) ◽  
pp. 74
Author(s):  
Jemmy Kurniawan ◽  
Pudji Rahaju ◽  
Soehartono Soehartono
Keyword(s):  
Blood Lactate ◽  
Lactate Level ◽  
Elevated Level ◽  
Hypoxia Inducible Factor ◽  
Blood Lactate Level ◽  
Cross Sectional ◽  
Hypoxia Inducible Factor 1 ◽  
Nasopharyngeal Tissue ◽  
Lactate Levels ◽  
The Impact

Latar Belakang: Karsinoma nasofaring (KNF) merupakan keganasan tersering pada kepala dan leher. Pilihan terapi KNF adalah radioterapi dan kemoterapi yang berhubungan dengan toksisitas, resistensi obat, dan rekurensi. Intervensi metabolik yang didasarkan pada perubahan metabolisme sel kanker merupakan salah satu strategi terapi kanker pada saat ini. Untuk dapat mengetahuinya perlu dipahami pengaruh ekspresi p53 dan hypoxia-inducible factor 1 (HIF1) terhadap peningkatan kadar laktat jaringan nasofaring pada pasien KNF. Tujuan: Mengetahui pengaruh ekspresi p53 dan HIF1 terhadap peningkatan kadar laktat jaringan nasofaring, dan untuk mengetahui kesesuaian antara kadar laktat darah dengan laktat jaringan nasofaring. Metode: Penelitian cross sectional melibatkan 10 subjek, dilakukan biopsi nasofaring dengan tuntunan nasoendoskopi untuk pemeriksaan histopatologi, ekspresi p53 dan HIF1 dengan imunohistokimia, laktat jaringan nasofaring dengan colorimetric, dan laktat darah. Hasil: Seluruh subjek mengalami peningkatan ekspresi p53 dan HIF1 dengan rerata p53 19,53±7,37 dan HIF1 24,30±12,28. Seluruh subjek penelitian memiliki kadar laktat jaringan meningkat, dengan rerata kadar laktat 0,67±0,39. Kadar laktat darah subjek cenderung meningkat dengan rerata 2,93±0,65. Terdapat pengaruh peningkatan ekspresi p53 terhadap peningkatan kadar laktat jaringan (p=0,002). Terdapat pengaruh peningkatan ekspresi HIF1 terhadap peningkatan kadar laktat jaringan (p=0,042). Tidak terdapat kesesuaian antara kadar laktat darah dengan laktat jaringan nasofaring (p=0,000). Kesimpulan: Peningkatan ekspresi p53 dan HIF1 berpengaruh terhadap peningkatan kadar laktat jaringan nasofaring pada pasien KNF, namun kadar laktat darah tidak menggambarkan kadar laktat jaringan nasofaring. ABSTRACTBackground: Nasopharyngeal carcinoma (NPC) is the most frequent malignancy of the head and neck. The options of NPC therapy are radiotherapy and chemotherapy, associated with toxicity, drug resistance, and recurrence. Metabolic intervention based on changes in cancer cell metabolism is currently one of the strategies of cancer therapy. Aim: To determine the impact of p53 and hypoxia-inducible factor 1 (HIF1) expression on elevated lactate levels of nasopharyngeal tissue, and to determine the compatibility between blood lactate and nasopharyngeal tissue lactate levels in patients with NPC. Method: This cross-sectional study involved 10 subjects who underwent nasopharyngeal biopsy for histopathologic examination, p53 and HIF1 expression using immunohistochemistry, lactate of nasopharyngeal tissue using colorimetric, and blood lactate. Results: All subjects had increased expression of p53 and HIF1 with p53 mean of 19.53±7.37 and HIF1 mean of 24.30±12.28. All subjects had elevated tissue lactate levels, with lactate levels mean of 0.67±0.39. The blood lactate level of the subjects increased, with blood lactate level mean of 2.93±0.65. There was a significant increasing impact of p53 expression on tissue lactate elevated level (p=0.002) and a significant increasing impact of HIF1 expression on tissue lactate elevated level (p=0.042). There was no correlation between lactate levels of blood lactate and nasopharyngeal tissue (p=0.000). Conclusion: Increased expression of p53 and HIF1 had an effect on increased levels of lactate nasopharyngeal tissue in NPC patients, but blood lactate levels did not have a correlation with lactate levels of nasopharyngeal tissue.

scholarly journals The Validity of SOFA Score to Predict Mortality in Adult Patients with Cardiogenic Shock on Venoarterial Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Mohamed Laimoud ◽  
Mosleh Alanazi
Keyword(s):  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Blood Lactate ◽  
Sofa Score ◽  
Lactate Level ◽  
Blood Lactate Level ◽  
Ecmo Support ◽  
Adult Patients ◽  
The Mean ◽  
Va Ecmo

Background. Venoarterial ECMO is increasingly used in resuscitation of adult patients with cardiogenic shock with variable mortality reports worldwide. Our objectives were to study the variables associated with hospital mortality in adult patients supported with VA-ECMO and to determine the validity of repeated assessments of those patients by the Sequential Organ Failure Assessment (SOFA) score for prediction of hospital mortality. We retrospectively studied adult patients admitted to the cardiac surgical critical care unit with cardiogenic shock supported with VA-ECMO from January 2015 to August 2019 in our tertiary care hospital. Results. One hundred and six patients supported with VA-ECMO were included in our study with in-hospital mortality of 56.6%. The mean age of studied patients was 40.2 ± 14.4 years, and the patients were mostly males (69.8%) with a mean BMI of 26.5 ± 7 without statistically significant differences between survivors and nonsurvivors. Presence of CKD, chronic atrial fibrillation, and cardiac surgeries was significantly more frequent in the nonsurvivors group. The nonsurvivors had more frequent AKI (p<0.001), more haemodialysis use (p<0.001), more gastrointestinal bleeding (p=0.039), more ICH (p=0.006), and fewer ICU days (p=0.002) compared to the survivors group. The mean peak blood lactate level was 11 ± 3 vs 16.7 ± 3.3, p<0.001, and the mean lactate level after 24 hours of ECMO initiation was 2.2 ± 0.9 vs 7.9 ± 5.7, p<0.001, in the survivors and nonsurvivors, respectively. Initial SOFA score ≥13 measured upon ICU admission had a 85% sensitivity and 73.9% specificity for predicting hospital mortality [AUROC = 0.862, 95% CI: 0.791–0.932; p<0.001] with 81% PPV, 79.1% NPV, and 80.2% accuracy while SOFA score ≥13 at day 3 had 100% sensitivity and 91.3% specificity for predicting mortality with 93.8% PPV, 100% NPV, and 96.2% accuracy [AUROC = 0.995, 95% CI: 0.986–1; p<0.001]. The ∆1 SOFA (3-1) ≥2 had 95% sensitivity and 93.5% specificity for predicting hospital mortality [AUROC = 0.958, 95% CI: 0.913–1; p<0.001] with 95% PPV, 93.5% NPV, and 94.3% accuracy. SOFA score ≥15 at day 5 had 98% sensitivity and 100% specificity for predicting mortality with 99% accuracy [AUROC = 0.994, 95% CI: 0.982–1; p<0.001]. The ∆2 SOFA (5-1) ≥2 had 90% sensitivity and 97.8% specificity for predicting hospital mortality [AUROC = 0.958, 95% CI: 0.909–1; p<0.001] with 97.8% PPV, 90% NPV, and 94.8% accuracy. Multivariable regression analysis revealed that increasing ∆1 SOFA score (OR = 2.506, 95% CI: 1.681–3.735, p<0.001) and increasing blood lactate level (OR = 1.388, 95% CI: 1.015–1.898, p=0.04) were significantly associated with hospital mortality after VA-ECMO support for adults with cardiogenic shock. Conclusion. The use of VA-ECMO in adult patients with cardiogenic shock is still associated with high mortality. Serial evaluation of those patients with SOFA score during the first few days of ECMO support is a good predictor of hospital mortality. Increase in SOFA score after 48 hours and hyperlactataemia are significantly associated with increased hospital mortality.

scholarly journals Blood lactate level in Elite boy swimmers after lactate tolerance exercise test

2017 ◽  
Vol 4 (05) ◽  
pp. 1318
Author(s):  
Asghar Nikseresht ◽  
Iman Yabande ◽  
Karamatollah Rahmanian ◽  
Abdolreza Sotoodeh Jahromi
Keyword(s):  
Blood Lactate ◽  
Exercise Test ◽  
High Intensity ◽  
Lactate Level ◽  
Baseline Level ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Blood Lactate Level ◽  
Enzymatic Method ◽  
The Mean

Introduction: To avoid injuries during high-intensity sports training, it is important to recognize conditions of bodily consumption and production of adequate energy; exercise increases the concentration of the blood lactate. This paper is an attempt to compare pre and post lactate tolerance exercise test - blood lactate concentrations - of elite boy swimmers. Methods: Blood lactates are measured by an enzymatic method on 12 subjects 30 minutes before and adjust and 24 hours after the test. Results: The mean lactate concentration of 30.35±12.16 mg/dl is observed in swimmers 30 minutes before the test. Swimmers adjust after the test show mean blood lactate concentration of 108.52±18.17 mg/dl that is significantly higher than 30 minutes before the test (p<0.001). Then blood lactate level decreases below baseline level at 24 hours after the test. Conclusion: Blood lactate increases with the test and decreases below baseline within 24 hours after the test. 

scholarly journals Sequential blood lactate measurement as a predictor of mortality in patients with sepsis in the critical care unit

2021 ◽  
Author(s):  
Pollov Borah ◽  
Dilip Kumar Saloi ◽  
Bipul Deka ◽  
Ranjumoni Konwar ◽  
Deepjyoti Kalita ◽  
...  
Keyword(s):  
Critical Care ◽  
Severe Sepsis ◽  
Blood Lactate ◽  
Critical Care Unit ◽  
Clinical Status ◽  
Tertiary Care ◽  
P Value ◽  
The Mean ◽  
Lactate Levels ◽  
Blood Lactate Levels

Abstract Background and objectiveIn severe sepsis, increased blood lactate levels are observed indicating impaired oxidative phosphorylation, which secondarily causes hypoxic hypoxia and stagnant tissue hypoxia. Among all other related factors, a high rise of the lactate level in blood may be a useful predictor of sepsis patients' mortality. This study aims to determine the association of consecutive blood lactate levels with the patient's mortality with sepsis admitted in the Critical Care Unit (CCU). MethodsThis prospective study included 50 patient of septicemia at CCU above 18 years in a tertiary care centre. On admission, at 24 hours and 72 hours, blood lactate levels were monitored. Their clinical status was evaluated for 28 days to categorise as survivor and non-survivor. The statistical analysis was made with Microsoft Excel and SPSS version 20. To test the difference in mean blood lactate levels among survivors and non-survivors Student’s t-test was applied. A p-value of less than 0.05 was considered significant. Prior ethical clearance from the institutional ethics committee of human with informed consent from the patients was obtained for data collection.ResultsThe current study included 50 patients of septicemia, 23 were survivors, and 27 were non-survivors after 28 days of follow up. The mean lactate range for the 23 survivors was ranged from 0.43 mmol/l to 5.69 mmol/l, whereas for non-survivors, it was 1.64 mmol/l to 6.14 mmol/l. The mean value of lactate for the survivors and non-survivors during admission, at 24 hours and at 72 hours were 0.9545±0.45798 vs 2.5204±1.51498, 1.2461±1.21360 vs 2.5107±1.63678 and 1.5496±1.66788 vs 2.7904±2.00160. The differences between the mean lactate values between survivors and non-survivors at different time intervals were highly significant.ConclusionA slower rate of lactate clearance during hospitalisation may be a significant factor associated with severe sepsis patient mortality. Thus serial blood lactate levels is a significant predictor of mortality and should be monitored.

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