scholarly journals Postoperative hyperlactatemia and serum lactate level trends among heart transplant recipients

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8334
Author(s):  
Anna Kędziora ◽  
Karol Wierzbicki ◽  
Jacek Piątek ◽  
Hubert Hymczak ◽  
Izabela Górkiewicz-Kot ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Lactate Level ◽  
Serum Lactate ◽  
Serum Lactate Level ◽  
Transplant Recipients ◽  
Arterial Blood ◽  
Subsequent Decrease ◽  
Heart Transplant Recipients ◽  
Lactate Levels ◽  
Peak Value

Background Advanced heart failure (HF), that affects 10% of the HF population, is associated with high mortality rate, meeting 50% at 1-year from diagnosis. For these individuals, heart transplantation (HTX) remains the ultimate and the gold-standard treatment option. Serum lactate level measurements has been proven useful for determining the outcome following other cardiac surgeries and among critically ill patients. Increased serum lactate levels are expected following HTX; however, no detailed analysis has been yet performed in this population. The research aims to estimate the prevalence of hyperlactatemia and describe early postoperative serum lactate level trends among heart transplant recipients. Materials and Methods Forty-six consecutive patients, who underwent HTX between 2010 and 2015, were enrolled into the retrospective analysis. Serum lactate level measurements within first 48 hours post-HTX were obtained every 6 hours from routinely conducted arterial blood gas analyses. The threshold for hyperlactatemia was considered at >1.6 mmol/L, according to upper limit of normal, based on internal laboratory standardization. The highest observed measurement within the observation, regardless of the time point of observation was determined for each patient individually and was appointed as Peak Value. Results Consecutively measured serum lactate levels differed in time (p = 0.000), with the initial increase and subsequent decrease of the values (4.3 vs. 1.9 mmol/l; p = 0.000). The increase from the baseline level to the Peak Value was statistically significant (4.3 vs. 7.0 mmol/l; p = 0.000). Various serum lactate level trends were identified, with one or more hyperlactatemia episodes. Eventually, 50% of the individuals had normal serum lactate levels at the end of the study, and hyperlactatemia was observed in the other half. Conclusions Throughout the observation, all of the patients experienced at least one episode of hyperlactatemia, with the median Peak Value of 7.0 (4.5–8.4) mmol/L. Various serum lactate level trends can be identified in post-HTX patients. Further research is required to determine the clinical usefulness of newly reported serum lactate level trends among heart transplant recipients.

scholarly journals Postoperative Serum Lactate Levels for In-Hospital Mortality Prediction Among Heart Transplant Recipients

2020 ◽  
Vol 25 ◽  
Author(s):  
Anna Kędziora ◽  
Karol Wierzbicki ◽  
Jacek Piątek ◽  
Hubert Hymczak ◽  
Izabela Górkiewicz-Kot ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Heart Transplant ◽  
Serum Lactate ◽  
Mortality Prediction ◽  
Transplant Recipients ◽  
Postoperative Serum ◽  
Heart Transplant Recipients ◽  
Lactate Levels

scholarly journals Role of Arterial Serum Lactate as a Predictor of Undifferentiated Shock on Admission and its Outcome- A Cohort Study

2021 ◽  
Author(s):  
Avadhesh Kumar Sharma ◽  
Nandakumar Beke ◽  
Dattatray Patki ◽  
Arun Bahulikar ◽  
Deepak Sadashiv Phalgune
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Lactate Level ◽  
Serum Lactate ◽  
Research Centre ◽  
Secondary Outcome ◽  
P Value ◽  
Serum Lactate Level ◽  
Icu Stay ◽  
Lactate Levels

Introduction: Patients with elevated serum lactate levels may be at risk for considerable morbidity and mortality and require a prompt, thoughtful and systematic approach for diagnosis and treatment. Aim: To find an association of on admission arterial serum lactate with outcome in Intensive Care Unit (ICU) patients. Materials and Methods: This observational cohort study was conducted on 168 patients at Poona Hospital and Research Centre, Pune, India, between June 2018 to November 2019 after obtaining Institutional Ethical Clearance. The patients included were above 18 years of age who had Systolic Blood Pressure (SBP) <90 mmHg, Heart Rate (HR) >100/min and Respiratory Rate (RR) >20/min. The arterial serum lactate level were examined on the day of admission, 12 hours and 24 hours. The need of ionotropic support, duration of ICU stay and mortality in one month was noted. The primary outcome measures were to study the association of on admission arterial serum lactate level with a duration of ICU stay and in-hospital mortality, whereas the secondary outcome measure was to study the association of on admission arterial serum lactate with the requirement of ionotropic support. Analysis of data was done using Statistical Package for Social Sciences for Windows, version 20.0. Results: The incidence in-hospital mortality was 20 (22.7%) out of 88 and 3 (3.8%) out of 80 in patients whose serum lactate levels on admission were >36 mg/dL and ≤36 mg/dL, respectively (p-value=0.002). The median duration of ICU stay was six and three days in patients whose serum lactate levels on admission were >36 mg/dL and ≤36 mg/dL, respectively (p-value=0.001). A 87 (98.9%) patients whose serum lactate levels >36 mg/dL on admission had the higher requirement of inotropes as compared to 35 (50.7%) patients whose serum lactate levels were ≤36 mg/dL. The percentage of patients whose serum lactate level >36 mg/dL, had a significantly higher Quick Sequential Organ Failure Assessment (qSOFA) scores and higher Shock Index (SI). There was a statistically significant positive correlation between serum lactate levels and qSOFA score (r=0.555) and SI (r=0.559). Conclusion: Initial serum lactate level was associated with higher in-hospital mortality, the higher requirement of inotropic support and longer duration of ICU stay.

Serum Lactate Level as a Predictor for Blood Transfusion in Postpartum Hemorrhage

2021 ◽  
Author(s):  
Surbhi Agrawal ◽  
Maria Smith ◽  
Robert Berg ◽  
Iffath A. Hoskins
Keyword(s):  
Blood Transfusion ◽  
Postpartum Hemorrhage ◽  
Lactate Level ◽  
Serum Lactate ◽  
Normal Serum ◽  
Red Blood Cell Transfusion ◽  
Blood Transfusions ◽  
Serum Lactate Level ◽  
Obstetric Hemorrhage ◽  
Lactate Levels

Objective Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality. At present, there are no reliable clinical or laboratory indicators to identify which patients might require blood transfusions during a PPH. Serum lactate has long been used as an early biomarker of tissue hypoperfusion in trauma settings. The aim of this study is to understand serum lactate's role in the management of obstetric hemorrhage. Study Design A retrospective chart review was performed of women who delivered between 2016 and 2019 at our institution and experienced a PPH. The patients were divided into two groups: those with a normal serum lactate level, defined as ≤2 mmol/L, and those with an abnormal serum lactate level, defined as >2 mmol/L. Need for packed red blood cell transfusion, as part of the resuscitation, was assessed for both groups. Results During the study period, 938 women experienced PPH. Of these, 108 (11.5%) had a normal serum lactate, ≤2 mmol/L, and 830 (88.5%) had an abnormal lactate, >2 mmol/L. Women with elevated lactate levels were more likely to receive a blood transfusion versus those with a normal lactate level (57.0 vs. 46.3%, p = 0.035, respectively). Additionally, the average number of blood transfusions administered was significantly higher in the abnormal lactate group versus in the normal lactate group (1.34 vs. 0.97, respectively, p = 0.004). In a multivariable linear regression model, increasing serum lactate levels were found to be predictive of requiring more than 1 unit of blood (p < 0.001). Conclusion Women with elevated serum lactate levels were more likely to require blood transfusions during a PPH versus those with a normal serum lactate level. Thus, serum lactate levels are useful as an early indicator of requirement for blood transfusion in the management of obstetric hemorrhage. Key Points

scholarly journals Comparative study of physiological changes of nil per oral vs glucose water vs free water in patients undergoing laparoscopic cholecystectomy: A randomized prospective study

2021 ◽  
Vol 8 (2) ◽  
pp. 205-208
Author(s):  
Neelesh Anand ◽  
Shashi Prakash ◽  
Mandeep M H Madia ◽  
Braj Nandan Singh ◽  
Reetika Gupta
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Blood Glucose ◽  
Lactate Level ◽  
Serum Lactate ◽  
Hypoglycaemic Episode ◽  
Serum Lactate Level ◽  
Clear Water ◽  
Serum Electrolytes ◽  
Arterial Blood ◽  
Glucose Water

The aim of this study was to compare the effect of ingestion of clear water and glucose water over 10 hours NPO in elective laparoscopic cholecystetctomy surgery.An observational study was conducted in Sir Sunderlal hospital, Banaras Hindu University. The study included ASA I-II patients undergoing laparoscopic cholecystectomy surgery. Patients undergoing general anaesthesia were included in the study. Among three groups, the control fasted in accordance to nil per os for 10 hours, second and third group received 200 mL of clear water and 200 ml of glucose water, respectively 2 hours before the surgery. Arterial Blood Gas analysis and blood glucose level was done in the immediate post-operative period. Arterial pH, serum electrolytes, serum lactate and blood glucose levels were compared for the above 3 groups. Results were given as mean ± SD. Data collected were analysed using Student’s t-test. Differences were considered statistically significant if P values were &#60;0.05. A total of 45 patients were included and 15 patients each were randomly assigned to one of the 3 groups. Patients who had 200 ml of clear water before surgery had lesser variation in serum K+ [p=0.045] and serum lactate level [p=0.001] than NPO. Patients fed with 200 ml of glucose water before surgery had lesser variation in serum K+ level [p=0.02], serum lactate level [p&#60;0.001], in Random Blood Sugar level [p&#60;0.001] and no episode of hypoglycaemia observed as compared to NPO. Patients given 200 ml of glucose water exhibited lesser variation in serum lactate level [p=0.004], in RBS level [p&#60;0.001] and no hypoglycaemic episode recorded contrary to those supplied with 200 mL of clear water. More fluctuations in extreme values of pH and serum electrolytes values observed in group A. Episodes of hypoglycaemia found more frequent in NPO and patients that received only clear water. No significant side-effects were observed in any group.We conclude that it is safe to give clear drinks 2 hours prior to surgery. Prolonged withholding of oral fluid may cause imbalance in pH, serum electrolytes and hypoglycaemia. The finding confirms the recent ASA guidelines which no longer recommends an indiscriminate ‘NPO after midnight’ policy.

scholarly journals Serum Lactate –An indicator of morbidity and mortality in polytrauma and multi-trauma patients

2013 ◽  
Vol 2 (1) ◽  
pp. 7-13 ◽  
Author(s):  
P Lamichhane ◽  
S Shrestha ◽  
B Banskota ◽  
AK Banskota
Keyword(s):  
Multiple Trauma ◽  
Blood Lactate ◽  
Lactate Level ◽  
Life Support ◽  
Serum Lactate ◽  
Morbidity And Mortality ◽  
Trauma Patients ◽  
Serum Lactate Level ◽  
Lactate Levels ◽  
Elevated Lactate

Background: The search for the best marker or set of markers for the diagnosis, prognosis and treatment of ‘at risk’ trauma patients is ongoing. Serial estimation of serum lactate values are thought to help predict morbidity and mortality in trauma victims. There is evidence to support the use of blood lactate levels as an end point of resuscitation. The presence of elevated lactic acid levels in the serum can direct the treating physician to safe and correct timing of any surgical intervention. Early identification and aggressive resuscitation measures aimed at correcting the impaired metabolic dysfunction improves survival and reduces complications in severely injured trauma patients. Methods: A prospective analytical study of 52 patients with polytrauma and multiple trauma admitted within 12 hours of injury to our institution between March 2007 to February 2008 was carried out. All the patients were resuscitated as per the advance trauma life support (ATLS) protocol in the emergency room. Serum lactate level was analyzed on the 1st, 5th and 14th day of injury. Serum lactate levels greater than 2 milimoles/L was considered abnormal and serum lactate level greater than 5 milimoles/L was considered significant. Results: There were 45 males and 7 females with an average age of 32.8 years (18-82). 18 patients out of 52 sustained polytrauma. Of these 18 patients, 8 patients sustained chest injury, 4 had head injury and 2 had abdominal injury. In the polytrauma group (n-18), 5 patients had an elevated lactate above 2 milimoles/Lon admission. 2 patients who had significant rise of lactate (>5 milimoles/L) on admission died on the 5th day. Out of 34 multiple trauma patients, 13 patients had an elevated lactate level at admission. One patient in this group with lactate level 7.2 died of ARDS on 3rd day of admission. Conclusion: Blood lactate appears to be a reliable marker reflecting not only the severity of the shock, but also for predicting survival. The longer the lactate is elevated, the more a patient is likely to develop multiple organ dysfunctions and die. Lactate levels followed over time is more reliable than isolated values. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8134 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 7-13

scholarly journals Laktátszintváltozások diabeteses ketoacidosisban és frissen diagnosztizált 1-es típusú diabetes mellitusban

2019 ◽  
Vol 160 (45) ◽  
pp. 1784-1790
Author(s):  
Kinga Jenei ◽  
Ildikó Szatmári ◽  
Eszter Szabó ◽  
Anjum Mariam ◽  
Andrea Luczay ◽  
...  
Keyword(s):  
Lactate Level ◽  
Lactate Concentration ◽  
Lactate Production ◽  
Serum Lactate ◽  
Total Serum ◽  
Serum Lactate Level ◽  
Newly Diagnosed ◽  
Lactate Levels ◽  
Diagnosed Diabetes ◽  
Newly Diagnosed Diabetes

Abstract: Introduction: It is known that lactate concentration is increased in diabetic ketoacidosis (DKA), however, the pathophysiology and kinetics of lactate changes are still unclear. Normally, L-lactate is the major form in the human body. According to previous data, also D- and L-lactate might be increased in hyperglycaemic disorders. Aim: We aimed to describe the kinetics and mechanisms of lactate concentration changes in ketoacidosis and newly diagnosed diabetes. Method: We performed a prospective study, including 5–18-year-old children with ketoacidosis (DKA, n = 13) and with newly diagnosed type 1 diabetes without ketoacidosis (T1DM, n = 6). We performed routine blood gas analysis 0–12–24–48 hours after admission, which also measured L-lactate levels. We also determined total venous serum lactate level by gas chromatography–mass spectrometry. Results: Initial plasma lactate concentration was increased in ketoacidosis as compared to the newly diagnosed diabetes group (p<0.05). After 12 h of rehydration, lactate levels were greatly reduced in ketoacidotic patients but after 24–48 h it was repeatedly increased (all p<0.01). In the 0–12 h phase, total serum lactate level was higher than L-lactate level, referring to D-lactate production. Conclusion: We described two L-lactate peaks in ketoacidosis. In the first 12 hours anaerobic glycolysis seems to have major role in hyperlactataemia. We assume that stimulated aerobic glycolysis leads to the second lactate peak. However, D-lactate is not routinely measured, it may contribute to the initial hyperlactataemia in both groups and is comparable to L-lactate production in ketoacidosis. Orv Hetil. 2019; 160(45): 1784–1790.

scholarly journals The Association of Perioperative Serum Lactate Levels with Postoperative Delirium in Elderly Trauma Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Cheol Lee ◽  
Juhwan Lee ◽  
Hyunho Cho ◽  
Jaekyeong Song ◽  
Hojung Jung ◽  
...  
Keyword(s):  
Lactate Level ◽  
Postoperative Delirium ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Serum Lactate Level ◽  
Multivariable Analyses ◽  
Lactate Levels ◽  
Elderly Trauma Patients

Background. Several studies have shown the utility of lactate level as a predictor of early outcomes in trauma patients. We conducted this study to evaluate the association of perioperative serum lactate levels with postoperative delirium (POD) in elderly trauma patients. Materials and Methods. This study included 466 elderly trauma patients with measurements of serum lactate levels on admission and 1 h after surgery. The associations of POD with serum lactate levels (on admission and 1 h after surgery) and lactate clearance were analyzed using Kendall’s correlation. Perioperative serum lactate levels and lactate clearance as predictors of POD were evaluated using univariate and multivariable analyses. Results. The incidence of POD in the present study was 38.1%. Serum lactate levels on admission and at 1 h after surgery were significantly higher in major trauma than in minor trauma. In univariate analysis of perioperative serum lactate levels and lactate clearance as predictors of POD, the odds ratio (OR) for serum lactate level on admission was 4.19 (P<0.01, 2.91 < 95% confidence interval (CI) < 6.02) and that 1 h after surgery was 3.83 (P<0.01, 2.79 < 95% CI < 5.25); however, the OR for serum change of lactate level was 0.99 ((P<0.09, 0.99 < 95% CI < 1.00). In multivariable analysis for predictors of POD, the OR for serum lactate level on admission was 2.40 (P<0.09, 0.87 < 95% CI < 6.7), that for serum lactate 1 h after surgery was 2.83 (P=0.01, 1.28 < 95% CI < 6.24), that for ICU admission was 3.01 (P=0.01, 2.09 < 95% CI < 6.03), and that for ISS was 1.47 (P<0.01, 1.27 < 95% CI < 3.70). Conclusions. Taking together the results of univariate and multivariable analyses, serum lactate level 1 h after surgery may be used as a prediction model of POD development in elderly trauma patients.

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