LABORATORIO DE URGENCIAS

 

385. Eur J Gastroenterol Hepatol. 2018 Nov;30(11):1361-1367. doi: 10.1097/MEG.0000000000001189.

Serum lactate level accurately predicts mortality in critically ill patients with cirrhosis with acute kidney injury.

Sun DQ(1), Zheng CF(2), Lu FB(3), Van Poucke S(4), Chen XM(5), Chen YP(3)(6), Zhang L(1), Zheng MH(3)(6)(7).

Author information:

(1)Department of Nephrology, Affiliated Wuxi Second Hospital, Nanjing Medical University, Wuxi.

(2)Department of Nephrology.

(3)Department of Hepatology, NAFLD Research Center.

(4)Department of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Genk, Belgium.

(5)Zhejiang Engineering Research Center of Intelligent Medicine, the First Affiliated Hospital of Wenzhou Medical University.

(6)Institute of Hepatology, Wenzhou Medical University.

(7)Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Wenzhou, China.

BACKGROUND AND AIM: Serum lactate levels are routinely measured in critically ill patients with cirrhosis, and hyperlactatemia is a common finding, but its prognostic value remains controversial. Our aim was to examine whether serum lactate level could be used as a predictor of outcome in critically ill patients with cirrhosis (CICP) with acute kidney injury (AKI).

PATIENTS AND METHODS: In this study, we included 480 consecutive patients with cirrhosis admitted to ICU, complicated with AKI, and were followed up for 365 days. Patients were divided into four groups (Q1-Q4) by serum lactate quartiles: Q1≤1.8 mg/dl, Q2=1.9-2.4 mg/dl, Q3=2.5-4.0 mg/dl, and Q4≥4.1 mg/dl. The hazard ratio (HR) and 95% confidence intervals (CIs) for hospital mortality were calculated across each quartile of serum lactate, using the Q1 as reference, and four models were built to adjust for the HR of mortality.
RESULTS: Compared with patients in the survival group, nonsurvivors had higher serum lactate levels. Mortality rate increased progressively as the serum lactate level increased (Q1: 56.06%, Q2: 62.16%, Q3: 72.73% and Q4: 75.86%), and this relationship remained statisticallysignificant after rigorous control of confounding factors in Q2, Q3, and Q4 with HRs of 1.03 (95% CI: 0.73-1.46), 1.40 (95% CI: 1.01-1.95), and 1.84 (95% CI: 1.28-2.64), respectively.
CONCLUSION: Our study brings a new perspective to the role of lactate monitoring in CICP with AKI. Elevated serum lactate levels are associated with a higher mortality rate in CICP with AKI. Elevated serum lactate levels should be part of rapid diagnosis and initiation of therapy to improve clinical outcome.

DOI: 10.1097/MEG.0000000000001189

PMID: 29916857 [Indexed for MEDLINE]

388. 
     Shock. 2018 Nov;50(5):545-550. doi: 10.1097/SHK.0000000000001128.

Prognostic Value of The Lactate/Albumin Ratio for Predicting 28-Day Mortality in Critically ILL Sepsis Patients.

Shin J(1), Hwang SY(1), Jo IJ(1), Kim WY(2), Ryoo SM(2), Kang GH(3), Kim K(4), Jo YH(4), Chung SP(5), Joo YS(5), Beom JH(5), Yoon YH(6), Han KS(7), Lim TH(8), Choi HS(9), Kwon WY(10), Suh GJ(10), Choi SH(6), Shin TG(1); Korean Shock Society (KoSS) Investigators.

Author information:

(1)Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

(2)Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

(3)Department of Emergency Medicine, Hallym University College of Medicine KangNam Medical Center, Seoul, Korea.

(4)Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

(5)Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.

(6)Department of Emergency Medicine, Guro Hospital, Korea University Medical Center, Seoul, Korea.

(7)Department of Emergency Medicine, Korea University Anam Hospital, Seoul, Korea.

 

AIM: The aim of this study was to evaluate the clinical utility of the lactate/albumin (L/A) ratio as a predictive factor of 28-day mortality in critically ill sepsis patients.
METHODS: This is a retrospective observational study from a prospectively collected multicenter registry of 10 emergency departments (EDs) in teaching hospitals that participated in the Korean Shock Society. It enrolled patients who were 19 years of age or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion. The prognostic performance of the L/A ratio and lactate level for predicting 28-day mortality was assessed.
Lactate and albumin levels were measured immediately after ED arrival.
RESULTS: A total of 946 patients were included, with 22.5% overall 28-day mortality. The area under the receiver operating characteristic curve (AUROC) value of the L/A ratio (0.69, 95% confidence interval [CI] 0.64-0.73, P < 0.01) was higher than that of lactate (0.65, 95% CI 0.61-0.70, P < 0.01) for predicting 28-day mortality. The optimal cutoff of the L/A ratio was 1.32. The AUROC value of the L/A ratio was better than that of lactate regardless of lactate level (normal [<2.0 mmol/L]: 0.68 vs. 0.55; intermediate [≥2.0, < 4.0 mmol/L]: 0.65 vs. 0.50; high [≥4.0 mmol/L]: 0.66 vs. 0.62). In the subgroup with decreased lactate elimination, the AUROC value of the L/A ratio was also significantly higher than that of lactate (hepatic dysfunction: 0.70 vs. 0.66; renal dysfunction: 0.71 vs. 0.67). The L/A ratio cut-off and hypoalbminemia showed further discriminative value for 28-day mortality even in patients with normal or intermediate lactate levels.
CONCLUSIONS: The prognostic performance of the L/A ratio was superior to that of a single lactate measurement for predicting 28-day mortality of critically ill sepsis patients. L/A ratio can be a useful prognostic factor regardless of initial lactate level and the presence of hepatic or renal dysfunction.

DOI: 10.1097/SHK.0000000000001128

PMID: 29461463 [Indexed for MEDLINE]

393. 
     BMC Anesthesiol. 2018 Oct 24;18(1):152. doi: 10.1186/s12871-018-0618-1.

Does lactate clearance prognosticates outcomes in ECMO therapy: a retrospective observational study.

Mungan İ(1), Kazancı D(2), Bektaş Ş(2), Ademoglu D(2), Turan S(2).

Author information:

(1)Department of Intensive Care Unit, Turkey Advanced Speciality Education and Research Hospital, Altındag, Ankara, Turkey.

(2)Department of Intensive Care Unit, Turkey Advanced Speciality Education and Research Hospital, Altındag, Ankara, Turkey.

 

BACKGROUND: ECMO support is a final treatment modality for patients in the refractory cardiogenic arrest and postcardiotomy cardiogenic shock with an utmost importance. Eventhough it is linked to high mortality, its usage gains popularity worldwide. We assessed the fluctuation of lactate levels and the clearance of lactate during the ECMO therapy and its prognostic role on mortality.
METHODS: Data were gathered on all patients receiving ECMO therapy longer than 48 h between January 2015 and December 2017 retrospectively. Blood lactate had been recorded before ECMO implantation and at specific time points during ECMO support as a routine procedure. In this study, the Lactate clearance at specific time points (Lactate clearance-1) and the duration that lactate cleared more than 10% of the initial lactate level (Lactate clearance-2) was measured. Statistical analysis included Mann Whitney U-test and ROC-curves to predict 30-day mortality.
RESULTS: Fourty-eight patients underwent ECMO therapy for refractory cardiogenic shock resulting in 70.8% mortality. The lactate levels before and after ECMO therapy as well as the dynamic changes were significantly correlated with mortality variable. With AUC calculation, LC-2 has a strong discrimination (AUC = 0.97) on 30-day survivors and nonsurvivors. LAE-LBE (AUC = 0.785), L48-LBE (AUC = 0.706) showed moderate predictive power on 30-day mortality.
CONCLUSIONS: Changes in lactate levels after ECMO implantation is an important tool to assess effective circulatory support and it is found superior to single lactate measurements as a prognostic sign of mortality in our study. Based on our results, an early insertion of ECMO before lactate gets high was suggested. Serial changes on lactate levels and calculation of its clearance may be superior to single lactate on both effective circulatory support and as prognostic prediction. LC-2 showed a strong discrimination on 30-day mortality.

DOI: 10.1186/s12871-018-0618-1

PMCID: PMC6201528

PMID: 30355289 [Indexed for MEDLINE]

402. 
     Biomed Res Int. 2018 Oct 2;2018:8014213. doi: 10.1155/2018/8014213. eCollection 2018.

Blood Lactate or Lactate Clearance: Which Is Robust to Predict the Neurological Outcomes after Cardiac Arrest? A Systematic Review and Meta-Analysis.

Zhou BC(1), Zhang Z(2), Zhu JJ(1), Liu LJ(1), Liu CF(3).

Author information:

(1)Department of Emergency and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, No. 1055, San Xiang Road, Suzhou 215004, Jiangsu, China.

(2)Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Suzhou, Jiangsu Province 215123, China.

(3)Department of Neurology, The Second Affiliated Hospital of Soochow University, No. 1055, San Xiang Road, Suzhou 215004, Jiangsu, China.

AIMS: Lactate and lactate clearance were supposed to be associated with cardiac arrest outcomes, but studies obtained different results. Thus, we conducted this meta-analysis to investigate the association between lactate or lactate clearance and neurological outcomes and their usefulness for prediction of neurological outcomes.
METHODS: We conducted a systematic search in PubMed, Web of science, EMBASE, Medline, and Google Scholar until May 1, 2018, for relevant studies. Studies reporting lactate, lactate clearance on admission, or other time points after admission associated with neurological outcomes were included in our analysis. Pooled effect date was shown as weighed mean difference (WMD) and 95% confidence interval (CI). To measure the usefulness of lactate on admission to predict neurological outcomes, we also pooled the data of diagnostic test.
RESULTS: 23 studies involving 6720 cardiac arrest (CA) patients were included. Results from our analysis indicated that patients with good neurological outcomes tended to have a lower lactate level on admission (WMD: -2.66 mmol/L, 95%CI: -3.39 to -1.93) and 12h, 24h, and 48h after admission (P<0.001). Furthermore, the pooled AUC for lactate level on admission to predict neurological outcomes was 0.77 (95%CI: 0.73-0.80). However, a significant association between lactate clearance and neurological outcomes was only found in 24h but not 12h lactate clearance rate.
CONCLUSIONS: Lactate levels on admission and all time points up to 48h were associated with neurological outcomes after CA, whereas the association between lactate clearance and neurological outcomes was not so stable. Lactate was a more robust surrogate marker than lactate clearance to predict neurological outcomes after CA.

DOI: 10.1155/2018/8014213

PMCID: PMC6189651

PMID: 30370306 [Indexed for MEDLINE]

404. 
     Math Biosci Eng. 2018 Oct 1;15(5):1225-1242. doi: 10.3934/mbe.2018056.

Analysis of a mathematical model for brain lactate kinetics.

Guillevin C(1), Guillevin R, Miranville A, Perrillat-Mercerot A.

Author information:

(1)Université de Poitiers, Laboratoire de Mathématiques et Applications, UMR CNRS 7348, Equipe DACTIM-MIS, CHU de Poitiers, 2 Rue de la Milétrie, F-86021 Poitiers, France.

The aim of this article is to study the well-posedness and properties of a fast-slow system which is related with brain lactate kinetics. In particular, we prove the existence and uniqueness of nonnegative solutions and obtain linear stability results. We also give numerical simulations with different values of the small parameter ε and compare them with experimental data.

DOI: 10.3934/mbe.2018056

PMID: 30380308 [Indexed for MEDLINE]

409. 
     Scand J Clin Lab Invest. 2018 Oct;78(6):508-514. doi: 10.1080/00365513.2018.1514650. Epub 2018 Oct 1.

Plasma lactate at admission does not predict mortality and complications in hip fracture patients: a prospective observational study.

Jonsson MH(1)(2), Hommel A(2)(3), Turkiewicz A(2)(4), Ekelund U(2)(5), Melander O(2)(6), Englund M(2)(4), Bentzer P(2)(7).

Author information:

(1)a Department of Anaesthesia and Intensive Care Medicine , Ystad Hospital , Ystad , Sweden.

(2)b Department of Clinical Sciences , Lund University , Lund , Sweden.

(3)c Department of Orthopaedics , Skåne University Hospital , Lund , Sweden.

(4)d Clinical Epidemiology Unit Orthopaedics , Skåne University Hospital , Lund Sweden.

(5)e Department of Internal and Emergency Medicine , Skåne University Hospital , Lund , Sweden.

(6)f Department of Internal Medicine , Skåne University Hospital , Malmö , Sweden.

(7)g Department of Anaesthesia and Intensive Care Medicine , Helsingborg Hospital , Helsingborg , Sweden.

Hip fractures in elderly carry a high mortality. Our objective was to test the hypothesis that plasma lactate concentration at hospital admission can be used to identify patients with a high risk for poor outcome. Hip fracture patients admitted to a university hospital in Sweden from January 2011 to August 2014 in whom a venous lactate was obtained at admission were included in this prospective observational study. Primary outcome measure was 30-d mortality and secondary outcome measure was a composite outcome of 30-d mortality and postoperative complications. Lactate concentration was evaluated as a continuous predictor using logistic regression, crude and adjusted for age, gender and American Society of Anesthesiology Physical Status (ASA PS) score. Discrimination was evaluated using receiver operating characteristics (ROC) analysis. Totally, 690 patients were included. Median age was 84 years (interquartile range [IQR] 77-90). At 30-d follow-up, mortality was 7.2%, and 45% of the patients had suffered the composite outcome. Median lactate level was 1.3 mmol/L (IQR 1.0-1.8 mmol/L). The odds ratio (OR) by each 1.0 mmol/L increase in the lactate concentration for 30-d mortality was 1.13 (95% CI 0.77-1.68) while for the composite outcome it was 1.06 (95% CI 0.85-1.3). Similar results were obtained after adjustment for age, sex and ASA PS classification for both outcomes. Area under the ROC curve for lactate as a predictor of 30-d mortality was 0.51 (95% CI 0.45-0.57). In our cohort, plasma lactate at admission does not appear to be a useful biomarker to identify high-risk patients after hip fracture.

 

DOI: 10.1080/00365513.2018.1514650

PMID: 30270678 [Indexed for MEDLINE]

412. 
     J Pediatr Gastroenterol Nutr. 2018 Oct;67(4):483-487. doi: 10.1097/MPG.0000000000002043.

Intestinal Microbial and Metabolic Alterations Following Successful Fecal Microbiota Transplant for D-Lactic Acidosis.

Bulik-Sullivan EC(1), Roy S(2), Elliott RJ(3), Kassam Z(3), Lichtman SN(2), Carroll IM(1)(4), Gulati AS(2)(4)(5).

Author information:

(1)Department of Nutrition, School of Medicine.

(2)Department of Pediatrics, Division of Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC.

(3)OpenBiome, Somerville, MA.

(4)Center for Gastrointestinal Biology and Disease, School of Medicine.

(5)Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Fecal microbiota transplantation (FMT) involves the transfer of stool from a healthy individual into the intestinal tract of a diseased recipient. Although used primarily for recurrent Clostridium difficile infection, FMT is increasingly being attempted as an experimental therapy for other illnesses, including metabolic disorders. D-lactic acidosis (D-LA) is a metabolicdisorder that may occur in individuals with short bowel syndrome when lactate-producing bacteria in the colon overproduce D-lactate. This results in elevated systemic levels of D-lactate, metabolic acidosis, and encephalopathy. In this study, we report the successful use of FMT for the treatment of recurrent D-LA in a child who was unresponsive to conventional therapies. Importantly, we also present profiles of the enteric microbiota, as well as fecal D-/L-lactic acid metabolites, before and longitudinally after FMT. These data provide valuable insight into the putative mechanisms of D-LA pathogenesis and its treatment.

DOI: 10.1097/MPG.0000000000002043

PMID: 29901551 [Indexed for MEDLINE]

423. 
     J Pharm Biomed Anal. 2019 Jan 30;163:1-8. doi: 10.1016/j.jpba.2018.09.028. Epub 2018 Sep 19.

An enzyme-modified capillary as a platform for simultaneous fluorometric detection of d-glucose and l- lactate.

Shoji A(1), Takahashi Y(2), Osato S(2), Sugawara M(2).

Author information:

(1)Department of Chemistry, College of Humanities and Sciences, Nihon University, Sakurajousui, Setagaya, Tokyo, 156-8550, Japan; School of Pharmacy, Tokyo University of Pharmacy and Life Science, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan.

(2)Department of Chemistry, College of Humanities and Sciences, Nihon University, Sakurajousui, Setagaya, Tokyo, 156-8550, Japan.

The preparation of a glass capillary pattered with lipid layers on which lactate dehydrogenase (LDH) and glucose dehydrogenase (GDH) were regionally adsorbed and its application for simultaneous detection of d-glucose and l-lactate in human serum is described. A lipid layer was formed on the surface of BSA-unabsorbed octadecyltrichlorosilane (OTS) inner wall of a glass capillary. The electrostatic charge of the lipid layer was a key factor for adsorbing the enzymes on the lipid layer. The fluorescence intensities were observed at each enzyme site in the presence of diaphorase (DIA), β-nicotinamide-adenine dinucleotide oxidized (NAD), resazurin, d-glucose and l-lactate. The fluorescence intensities at each enzyme site increased with an increase in the concentration of d-glucose and l-lactate=with the detection limits of 32 μM and 4.9 μM, respectively.

DOI: 10.1016/j.jpba.2018.09.028

PMID: 30268727 [Indexed for MEDLINE]

427. 
     Scand J Trauma Resusc Emerg Med. 2018 Sep 10;26(1):75. doi: 10.1186/s13049-018-0537-7.

Peripheral measurements of venous oxygen saturation and lactate as a less invasive alternative for hemodynamic monitoring.

Chemtob RA(1), Møller-Sørensen H(2).

Author information:

(1)Department of Cardiothoracic Anaesthesiology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.

 (2)Department of Cardiothoracic Anaesthesiology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.

BACKGROUND: Peripheral measurement of venous oxygen saturation and lactate is a less invasive alternative to monitor tissue oxygenation as compared to measurements from a central venous catheter. However, there is a lack of evidence to support the use of peripheral measurements. In this study, we investigated the agreement between central and peripheral venous oxygen saturation and lactate.
METHODS: We conducted a prospective observational study including 115 patients who underwent elective cardiac surgery between April and May 2015 at Rigshospitalet, Copenhagen, Denmark. Measurements were obtained simultaneously at induction of anaesthesia, upon arrival in the ICU and 3-4 h postoperatively. Bias and trending ability was identified using Bland-Altman analysis and a four-quadrant plot.
RESULTS: Bias was 13.37% for venous oxygen saturation preoperatively (95% CI: 11.52-15.22, LoA: ±19.10, PE: 22.08%), 11.29% at arrival to the ICU (95% CI: 8.81-13.77, LoA: ±25.10, PE: 32.39%) and 16.49% at 3-4 h postoperatively (95% CI: 14.16-18.82, LoA: ±21.20, PE: 26.82%). A four-quadrant plot demonstrated an 89% concordance. Central and peripheral lactate showed a bias of 0.14 mmol/L preoperatively (95% CI: 0.11-0.17, LoA: ±0.30, PE: 32.08%), 0.16 mmol/L at arrival to ICU (95% CI: 0.09-0.23, LoA: ±0.70, PE: 38.88%) and 0.23 mmol/L at 3-4 h postoperatively (95% CI: 0.11-0.35, LoA: ±0.50, 25.18%).
DISCUSSION: Measurements of peripheral oxygen saturation and lactate may be valuable in an emergency setting, avoiding unnecessary and time consuming application of a CVC.
CONCLUSION: We found a high bias but an acceptable trending ability between central and peripheral venous oxygenation. Central and peripheral lactate had excellent agreement. Further studies are necessary to validate the use of peripheral venous samples to identify patients at risk of impaired tissue oxygenation.

DOI: 10.1186/s13049-018-0537-7

PMCID: PMC6131814

PMID: 30201000 [Indexed for MEDLINE]

428. 
     Exp Clin Endocrinol Diabetes. 2019 Sep;127(8):557-566. doi: 10.1055/a-0672-0908. Epub 2018 Sep 10.

Interaction Between Lactate and Uric Acid is Associated With a Higher Prevalence of Metabolic Syndrome: A Community-Based Study.

Pan H(1), Yan D(1), Xu M(1), Li F(1), Ren M(1), Zhang J(1), Wu M(1).

Author information:

(1)Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.

BACKGROUND: Increased blood lactate or uric acid (UA) levels are associated with an increased risk of metabolic syndrome (MS). The aim of this study was to investigate the effect of an interactive association between blood lactate and UA levels on MS.
METHODS: This community-based cross-sectional study included 2584 Chinese subjects aged ≥ 18 years. Participants were classified into 3 groups based on lactate or UA level tertiles or into 9 groups based on a combination of lactate and UA level tertiles.
RESULTS: The serum high-sensitivity C-reactive protein (hs-CRP) and homeostatic  model assessment of insulin resistance (HOMA-IR) levels and odds ratios (ORs) for MS increased across the blood lactate or UA level tertiles (all P for trend<0.05). Interactions between lactate and UA with hs-CRP level, HOMA-IR level, and ORs for MS (P<0.05 for all interactions) were also observed. The adjusted ORs for MS in participants in the third tertile of lactate and UA levels, in the third tertile of lactate levels and first tertile of UA levels, and in the first tertile of lactate levels and third tertile of UA levels were 6.02 (95% CI 2.87-12.64, P<0.001), 2.92 (95% CI 1.39-6.10, P=0.005), and 2.70 (95% CI 1.23-5.96, P=0.014), respectively, compared with those in the first tertiles of both lactate and UA levels.
CONCLUSION: The interaction between lactate and UA is associated with a higher prevalence of MS in the Chinese population.

DOI: 10.1055/a-0672-0908

PMID: 30199916 [Indexed for MEDLINE]

435. 
     Pediatr Emerg Care. 2018 Sep;34(9):e165-e167. doi: 10.1097/PEC.0000000000001603.

Lactic Acidosis in a Critically Ill Patient: Not Always Sepsis.

Schuh AM, Leger KJ(1), Summers C(1), Uspal NG(2).

Author information:

(1)Division of Pediatric Hematology-Oncology, and.

(2)Division of Pediatric Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA.

Lactic acidosis in the emergency department and other hospital settings is typically due to tissue hypoxia with sepsis being the most common cause. However, in patients with persistently elevated lactate without evidence of inadequate oxygen delivery, type B lactic acidosis should be considered. We report the case of a 12-year-old boy with relapsed and refractory pre-B-cell acute lymphoblastic leukemia who presented in distress with tachycardia, history of fever, and diffuse abdominal tenderness. The patient had severe metabolic acidosis with elevated lactate upon arrival to the emergency department. Despite aggressive fluid resuscitation and intravenous antibiotics, the patient's acidosis worsened. Serial blood cultures were negative, and he was eventually diagnosed with type B lactic acidosis secondary to relapsed acute lymphoblastic leukemia.

DOI: 10.1097/PEC.0000000000001603

PMID: 30180106 [Indexed for MEDLINE]

442. 
     Shock. 2018 Sep;50(3):286-292. doi: 10.1097/SHK.0000000000001066.

Association of Clinical Hypoperfusion Variables With Lactate Clearance and Hospital Mortality.

Londoño J(1)(2), Niño C(1), Díaz J(1), Morales C(3)(4), León J(3)(4), Bernal E(2)(5), Vargas C(4), Mejía L(1)(4), Hincapié C(6), Ascuntar J(6), León A(6), Jaimes F(1)(6)(7).

Author information:

(1)Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Medellin, Colombia.

(2)Hospital Pablo Tobón Uribe, Medellin, Colombia.

(3)Department of General Surgery, School of Medicine, Universidad de Antioquia, Medellin, Colombia.

(4)Hospital Universitario San Vicente Fundación, Medellin, Colombia.

(5)Clinical Trials Unit, University College London, London, UK.

(6)Grupo Académico de Epidemiología Clínica (GRAEPIC)-Clinical Epidemiology Academic Research Group, School of Medicine, Universidad de Antioquia, Medellin, Colombia.

(7)Medical Research Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia.

BACKGROUND: Lactate has shown utility in assessing the prognosis of patients admitted to the hospital with confirmed or suspected shock. Some findings of the physical examination may replace it as screening tool. We have determined the correlation and association between clinical perfusion parameters and lactate at the time of admission; the correlation between the change in clinical parameters and lactate clearance after 6 and 24 h of resuscitation; and the association between clinical parameters, lactate, and mortality.
METHODS: Prospective cohort study of adult patients hospitalized in the emergency room with infection, polytrauma, or other causes of hypotension. We measured serum lactate, capillary refill time, shock index, and pulse pressure at 0, 6, and 24 h after admission. A Spearman's correlation was performed between clinical variables and lactate levels, as well as between changes in clinical parameters and lactate clearance. The operative characteristics of these variables were determined by area under the receiver operating characteristic curve analysis and the association between lactate, clinical variables, and mortality through logistic regression.
RESULTS: A total of 1,320 patients met the inclusion criteria, 66.7% (n = 880) confirmed infection, 19% (n = 251) polytrauma, and 14.3% (n = 189) another etiology. No significant correlation was found between any clinical variable and lactate values (r < 0.28). None of the variable had an adequate discriminatory capacity to detect hyperlactatemia (AUC < 0.62). In the multivariate model, lactate value at admission was the only variable independently associated with mortality (OR 1.2; 95% CI = 1.1-1.1).
CONCLUSIONS: Among patients with hypoperfusion risk or shock, no correlation was found between clinical variables and lactate. Of the set of parameters collected, lactate at admission was the only independent marker of mortality.

DOI: 10.1097/SHK.0000000000001066

PMID: 29206763 [Indexed for MEDLINE]

 

 

446. J Perinat Med. 2018 Aug 28;46(6):605-611. doi: 10.1515/jpm-2017-0044.

Relationship between various maternal conditions and lactic acid dehydrogenase activity in umbilical cord blood at birth.

Patavoukas E(1)(2), Åberg-Liesaho J(1)(2), Halvorsen CP(2)(3), Winbladh B(2)(3), Wiberg-Itzel E(1)(2).

Author information:

(1)Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden.

(2)Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden.

(3)Department of Pediatrics, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.

BACKGROUND: Lactic acid dehydrogenase (LDH) is a valuable marker for some of the most important diseases in newborns and the plasma LDH activity in newborns correlates well with conditions such as asphyxia. If LDH should be considered as a useful tool also in obstetric care, key factors associated with maternal health before and during pregnancy which could affect umbilical cord LDH activity need to be known. The aims of this study were to explore relationships between selected maternal conditions and arterial lactic acid dehydrogenase activity (aLDH) in umbilical cord blood at delivery.
METHODS: A prospective observational study was conducted at Sodersjukhuset, Stockholm, Sweden. Included in the study were 1247 deliveries, and cord blood samples from each were analyzed for aLDH. Background, delivery and neonatal data were collected from the medical records.
RESULTS: Higher median values of aLDH were found (P=0.001) among women with chronic disorders not related to pregnancy but there was no increased frequency of high aLDH levels (>612 μ/L, P=0.30). No difference in aLDH was identified between infants born to women with pregnancy-related disorders compared with healthy women, neither in median values, nor in high values (>612 μ/L, P=0.95).
CONCLUSION: Newborn infants born to women with non-pregnancy-related chronic disorders had a somewhat higher median value of aLDH in cord blood at delivery. The influence of common maternal conditions and diseases on umbilical cord arterial LDH levels is small compared to the increase reported in fetal distress and several other critical conditions in the newborn.

DOI: 10.1515/jpm-2017-0044

PMID: 28622146 [Indexed for MEDLINE]

462. 
     Pediatrics. 2018 Sep;142(3):e20180337. doi: 10.1542/peds.2018-0337. Epub 2018 Aug 8.

D-lactic Acidosis: Successful Suppression of D-lactate-Producing Lactobacillus by Probiotics.

Yilmaz B(1), Schibli S(2), Macpherson AJ(1), Sokollik C(3).

Author information:

(1)Department of Biomedical Research, Maurice Müller Laboratories, University Clinic of Visceral Surgery and Medicine, Inselspital and.

(2)University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland.

(3)University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland christiane.sokollik@insel.ch.

Intestinal microbiota composition in children with short bowel syndrome (SBS) is an important factor influencing the clinical outcome. An increase of D-lactate-producing bacteria can lead to D-lactic acidosis, also referred to as D-lactate encephalopathy, with severe neurologic impairment. Antibiotic treatments for D-lactic acidosis in children with SBS offer often only short-term relief. Here, we present the case of a boy with SBS who developed recurrent episodes of D-lactic acidosis even under continuous cycling antibiotic treatment. Microbiological analyses were used to detect the presence of D-lactate-producing Lactobacillus species in the stool samples. A probiotic cocktail was introduced to alter the intestinal microbiota. During follow-up under treatment with probiotics, the patient remained stable, and there was no additional need for antibiotic therapy for more than a year. Stool composition of the patient was sequenced regularly over that period. His microbiota profile changed completely in species richness, and a clustering of species according to probiotic usage was seen. Importantly, D-lactate-producing Lactobacillus strains disappeared within a few weeks after probiotic introduction and were no longer detected in the subsequent follow-up specimens.

DOI: 10.1542/peds.2018-0337

PMID: 30089656 [Indexed for MEDLINE]

472. 
     Crit Care Med. 2018 Aug;46(8):1276-1283. doi: 10.1097/CCM.0000000000003208.

Predictive Validity of Sepsis-3 Definitions and Sepsis Outcomes in Critically Ill Patients: A Cohort Study in 49 ICUs in Argentina.

Estenssoro E(1), Kanoore Edul VS(2), Loudet CI(1), Osatnik J(3), Ríos FG(4), Vázquez DN(5), Pozo MO(6), Lattanzio B(7), Pálizas F(6), Klein F(8), Piezny D(4), Rubatto Birri PN(9), Tuhay G(8), Díaz A(10), Santamaría A(11), Zakalik G(12), Dubin A(9); SATISEPSIS Investigators.

Author information:

(1)Hospital Interzonal de Agudos San Martin de La Plata, La Plata, Buenos Aires, Argentina.

(2)Hospital Juan A Fernández, Ciudad Autónoma de Buenos Aires, Argentina.

(3)Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina.

(4)Hospital Alejandro Posadas, El Palomar, Buenos Aires, Argentina.

(5)Sanatorio Anchorena, Ciudad Autónoma de Buenos Aires, Argentina.

(6)Clínica Bazterrica, Ciudad Autónoma de Buenos Aires, Argentina.

(7)Clínica Santa Isabel, Ciudad Autónoma de Buenos Aires, Argentina.

(8)Hospital Universitario Fundación Favaloro, Ciudad Autónoma de Buenos Aires, Argentina.

(9)Sanatorio Otamendi y Miroli, Ciudad Autónoma de Buenos Aires, Argentina.

(10)Hospital Misericordia, Ciudad de Córdoba, Córdoba, Argentina.

(11)Sanatorio de la Trinidad Mitre, Ciudad Autónoma de Buenos Aires, Argentina.

(12)Hospital Lagomaggiore, Ciudad de Mendoza, Mendoza, Argentina.

OBJECTIVES: The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; besides, regional information of sepsis outcomes is sparse. Our objective was to evaluate Sepsis-3 definition performance in Argentina.
DESIGN: Cohort study of 3-month duration beginning on July 1, 2016.
SETTINGS: Forty-nine ICUs.
PATIENTS: Consecutive patients admitted to the ICU with suspected infection that triggered blood cultures and antibiotic administration.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Patients were classified as having infection, sepsis (infection + change in Sequential Organ Failure Assessment ≥ 2 points), and septic shock (vasopressors + lactate > 2 mmol/L). Patients on vasopressors and lactate less than or equal to 2 mmol/L (cardiovascular dysfunction) were analyzed separately, as those on vasopressors without serum lactate measurement. Systemic inflammatory response syndrome was also recorded. Main outcome was hospital mortality. Of 809 patients, 6% had infection, 29% sepsis, 20% cardiovascular dysfunction, 40% septic shock, and 3% received vasopressors with lactate unmeasured. Hospital mortality was 13%, 20%, 39%, 51%, and 41%, respectively (p = 0.000). Independent predictors of outcome were lactate,
Sequential Organ Failure Assessment score, comorbidities, prior duration of symptoms (hr), mechanical ventilation requirement, and infection by highly resistant microorganisms. Area under the receiver operating characteristic curves for mortality for systemic inflammatory response syndrome and Sequential
Organ Failure Assessment were 0.53 (0.48-0.55) and 0.74 (0.69-0.77), respectively (p = 0.000).
CONCLUSIONS: Increasing severity of Sepsis-3 categories adequately tracks mortality; cardiovascular dysfunction subgroup, not included in Sepsis-3, has distinct characteristics. Sequential Organ Failure Assessment score shows adequate prognosis accuracy-contrary to systemic inflammatory response syndrome.
This study supports the predictive validity of Sepsis-3 definitions.

DOI: 10.1097/CCM.0000000000003208

PMID: 29742584 [Indexed for MEDLINE]

475. 
     Shock. 2018 Aug;50(2):162-166. doi: 10.1097/SHK.0000000000001055.

Effect of Dexmedetomidine on Lactate Clearance in Patients With Septic Shock: A Subanalysis of a Multicenter Randomized Controlled Trial.

Miyamoto K(1), Nakashima T(1), Shima N(1), Kato S(1), Ueda K(1), Kawazoe Y(2), Ohta Y(3), Morimoto T(4), Yamamura H(5); DESIRE Trial Investigators.

Author information:

(1)Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Japan.

(2)Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.

(3)Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.

(4)Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.

(5)Department of Disaster and Critical Care Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.

Lactate clearance is useful to guide initial resuscitation of patients with septic shock. We conducted this study to evaluate whether dexmedetomidine increases lactate clearance in patients with septic shock. This was a randomized controlled trial that involved a post hoc subgroup analysis. Adult patients with septic shock under ventilation were randomized to receive sedation strategy with or without dexmedetomidine (60 in the dexmedetomidine and 51 in the nondexmedetomidine groups). The primary outcome was the lactate clearance at 6 h, defined as the percent decrease in lactate from randomization to 6 h after.
The median Acute Physiology and Chronic Health Evaluation II score was 25 (interquartile range 19-31). The median serum lactate value at randomization was lower in the dexmedetomidine group than in the nondexmedetomidine group (4.0 mmol/L vs. 4.8 mmol/L; P = 0.053). The lactate clearance at 6 h was higher in the dexmedetomidine group, although this was not statistically significant (23.3 ± 29.8 vs. 11.1 ± 54.4, mean difference 12.2, 95% confidence interval (CI), -4.4 to 28.8). After adjusting for the lactate level at randomization, lactate clearance at 6 h was significantly higher in the dexmedetomidine group (adjusted mean difference 18.5, 95% CI, 2.2-34.9). There was no statistically significant difference in the 28-day mortality between the dexmedetomidine and the nondexmedetomidine groups (13 [22%] vs. 18 [35%] patients, P = 0.11). In
conclusion, among mechanically ventilated patients with septic shock, sedation with dexmedetomidine resulted in increased lactate clearance compared with sedation without dexmedetomidine.

DOI: 10.1097/SHK.0000000000001055

PMID: 29117063 [Indexed for MEDLINE]

481. 
     Appl Physiol Nutr Metab. 2019 Feb;44(2):179-186. doi: 10.1139/apnm-2018-0343. Epub 2018 Jul 30.

Does blood lactate predict the chronic adaptive response to training: A comparison of traditional and talk test prescription methods.

Preobrazenski N(1), Bonafiglia JT(1), Nelms MW(1)(1), Lu S(1)(1), Robins L(1)(1), LeBlanc C(1)(1), Gurd BJ(1).

Author information:

(1)School of Kinesiology and Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada.

The purpose of this study was to test the hypotheses (i) that interindividual variability in acute blood lactate responses during exercise at 65% of peak work rate (WRpeak; relative WRpeak protocol (REL)) will predict variability in the chronic responses to exercise training and (ii) that exercising at an intensity that causes uncomfortable speech production (negative talk test (TT) stage (NEG)) elicits high acute blood lactate responses and large adaptations to training. Twenty-eight participants completed 4 weeks of exercise training consisting of REL (n = 14) or NEG (TT, n = 14). Fifteen additional participants were assigned to a no-exercise control group (n = 15). In REL, acute blood lactate responses during the first training session significantly predicted changes in peak oxygen consumption (r = 0.69) after training. TT resulted in consistently high acute blood lactate responses. REL and TT improved (p < 0.05) peak oxygen consumption, WRpeak, and work rate at the onset of blood lactate accumulation (WROBLA). Despite nonsignificance, small to medium between-group effect sizes for changes in peak oxygen consumption, WRpeak, and WROBLA and a higher work rate, heart rate, rating of perceived exertion, and blood lactate during training at NEG support the potential superiority of TT over REL. When exercise is prescribed using a traditional method (a fixed percentage of WRpeak; REL), acute metabolic stress may partly explain the variance in the adaptations to training. In addition, TT elicited significant increases in peak oxygen consumption, WRpeak, and WROBLA, and although our small sample size limits our ability to confidently compare training adaptations between groups, our preliminary results suggest that future investigations with larger sample sizes should assess the potential superiority of TT over REL.

DOI: 10.1139/apnm-2018-0343

PMID: 30058347 [Indexed for MEDLINE]

484. 
     West J Emerg Med. 2018 Sep;19(5):827-833. doi: 10.5811/westjem.2018.6.37295. Epub 2018 Jul 26.

Serum Lactate and Mortality in Emergency Department Patients with Cancer.

Maher SA(1)(2), Temkit M(3), Buras MR(3), McLemore RY(3), Butler RK(1), Chowdhury Y(1), Lipinski CA(1)(2), Traub SJ(1)(2).

Author information:

(1)Mayo Clinic Arizona, Department of Emergency Medicine, Phoenix, Arizona.

(2)Mayo Clinic, College of Medicine, Rochester, Minnesota.

(3)Mayo Clinic Arizona, Division of Health Sciences Research, Phoenix, Arizona.

INTRODUCTION: Patients with malignancy represent a particular challenge for the emergency department (ED) given their higher acuity, longer ED length of stay, and higher admission rate. It is unknown if patients with malignancies and hyperlactatemia are at increased risk of mortality. If serum lactic acid could improve detection of at-risk patients with cancer, it would be useful in risk stratification. There is also little evidence that "alarm" values of serum lactate (such as >/=4 mmol/L) are appropriate for the population of patients with cancer.
METHODS: This was a continuous retrospective cohort study of approximately two years (2012-2014) at a single, tertiary hospital ED; 5,440 patients had serum lactic acid measurements performed in the ED. Of the 5,440 patients in whom lactate was drawn, 1,837 were cancer patients, and 3,603 were non-cancer patients. Cumulative unadjusted mortality (determined by hospital records and an external death tracking system) was recorded at one day, three days, seven days, and 30 days. We used logistic regression to examine the risk of mortality 30 days after the ED visit after adjusting for confounders.
RESULTS: In an unadjusted analysis, we found no statistically significant difference in the mortality of cancer vs. non-cancer patients at one day and three days. Significant differences in mortality were found at seven days (at lactate levels of <2 and 4+) and at 30 days (at all lactate levels) based on cancer status. After adjusting for age, gender, and acuity level, 30-day mortality rates were significantly higher at all levels of lactic acid (<2, 2-4, 4+) for patients with malignancy.
CONCLUSION: When compared with non-cancer patients, cancer patients with elevated ED lactic acid levels had an increased risk of mortality at virtually all levels and time intervals we measured, although these differences only reached statistical significance in later time intervals (Day 7 and Day 30). Our results suggest that previous work in which lactate "cutoffs" are used to risk-stratify patients with respect to outcomes may be insufficiently sensitive for patients with cancer. Relatively low serum lactate levels may serve as a marker for serious illness in oncologic patients who present to the ED.

DOI: 10.5811/westjem.2018.6.37295

PMCID: PMC6123084

PMID: 30202495 [Indexed for MEDLINE]

487. 
     Am J Emerg Med. 2019 May;37(5):823-827. doi: 10.1016/j.ajem.2018.07.046. Epub 2018 Jul 24.

Serum lactate as a predictor of neurologic outcome in ED patients with acute carbon monoxide poisoning.

Jung JW(1), Lee JH(2).

Author information:

(1)Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.

(2)Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea. Electronic address:

.
BACKGROUND: This study was conducted to assess and clarify the predictive risk factor of neurologic outcome in patients with acute carbon monoxide (CO) poisoning.
METHODS: A total of 453 patients with acute CO poisoning were admitted to the emergency department of Samsung Changwon Hospital from January 2010 to June 2017. Patients with acute CO poisoning who were followed for >6 months were studied. Initial Glasgow Coma Score (GCS), serum neuron-specific enolase (NSE), and lactate were measured after emergency department arrival. Patients were divided into two groups (good vs poor neurologic outcome).
RESULTS: A total of 432 patients (median age: 55 years, range: 17-91 years) were enrolled. There was a statistical difference between the good neurologic outcome group and the poor neurologic outcome group in terms of Exposure time, WBC, aspartate aminotransferase (AST), CK-MB, Troponin-I, creatinine kinase, NSE, lactate, CO-Hb, and GCS. NSE, lactate, and GCS were the early predictors of development of poor neurologic outcome. The areas under the curve in the ROC curve analysis for the GCS, NSE, and lactate were 0.842, 0.795, and 0.894,respectively.
CONCLUSION: Initial serum lactate level may correlate with the patient neurologic outcomes and prove to be a useful prognostic factor. Also NSE, and GCS might be a useful additional parameters that could predict the neurologic outcome on acute CO poisoned patients.

DOI: 10.1016/j.ajem.2018.07.046

PMID: 30154025 [Indexed for MEDLINE]

494. 
     BMC Res Notes. 2018 Jul 16;11(1):477. doi: 10.1186/s13104-018-3598-9.

Point-of-care umbilical arterial lactate and newborn outcomes in a low resource setting: cohort study.

Chilinda GK(1), Gadama LA(2), Stones W(3).

Author information:

(1)Department of Obstetrics and Gynaecology (Ethel Mutharika Maternity Wing), Kamuzu Central Hospital, Lilongwe, Malawi..

(2)Department of Obstetrics and Gynaecology, College of Medicine, Blantyre, Malawi.

(3)Departments of Public Health and Obstetrics & Gynaecology, College of Medicine, Blantyre, Malawi.

OBJECTIVE: Birth asphyxia contributes substantially to the burden of intrapartum stillbirth and neonatal mortality in resource limited countries. We investigated clinical correlates and neonatal outcomes of lactate analysis of umbilical arterial cord blood in a large referral maternity unit in Malawi using a point-of-care test (Lactate Xpress, Nova Biomedical, Runcorn, UK) and examined maternal and neonatal characteristics and outcomes.
RESULTS: There were 389 live births and 12 intrapartum stillbirths during the study. The median umbilical arterial lactate concentration was 3.4 mmol/L (interquartile range 2.6-4.9). Umbilical arterial lactate concentrations among the 45 babies admitted for special neonatal care were above 5 mmol/L in 16/45 (36%) of cases, with no fatality below 13 mmol/L. A positive malaria rapid diagnostic test was associated with hyperlactatemia (p < 0.05). In receiver-operator characteristic (ROC) analysis using a lactate cutoff of 5 mmol/L, areas under the curve were 0.72 (95% CI 0.66-0.79) and 0.64 (95% CI 0.58-0.69) for the Apgar score at 1 and 5 min respectively. This approach can identify safely those newborns that are unlikely to require additional monitoring. Scale-up implementation research in low resource country referral units is needed. The influence of malaria on neonatal hyperlactatemia requires further exploration.

DOI: 10.1186/s13104-018-3598-9

PMCID: PMC6048826

PMID: 30012214 [Indexed for MEDLINE]

510. 
     Clin Chem Lab Med. 2018 Jun 27;56(7):1100-1108. doi: 10.1515/cclm-2017-0733.

Higher D-lactate levels are associated with higher prevalence of small dense low-density lipoprotein in obese adolescents.

Rodríguez-Mortera R(1)(2), Luevano-Contreras C(1), Solorio-Meza S(3), Caccavello R(2), Bains Y(2), Garay-Sevilla ME(1), Gugliucci A(2)(4).

Author information:

(1)Department of Medical Science, University of Guanajuato, Guanajuato, Mexico.

(2)Glycation, Oxidation and Disease Laboratory, Department of Research, College of Osteopathic Medicine, Touro University, Vallejo, CA, USA.

(3)Mexican Institute of Social Security, Mexico City, Mexico.

(4)Touro University-California, 1310 Club Drive, 94592, Vallejo, CA, USA.

BACKGROUND: Childhood obesity is associated with insulin resistance (IR), increased levels of small dense low-density lipoprotein (sd-LDL) as well as with augmented hepatic de novo lipogenesis, which implies increased triose phosphate fluxes that may lead to increased methylglyoxal (MG) and its catabolic end product D-lactate. We hypothesized that obese adolescents have increased D-lactate serum levels associated with high incidence of sd-LDL.
METHODS: This is a cross-sectional study where the anthropometric characteristics, atherogenic dyslipidemia complex, sd-LDL (Lipoprint, Quantimetrix) and D-lactate (kinetic enzymatic analysis) were explored in 30 lean vs. 30 obese adolescents (16 females and 14 males per group) without metabolic syndrome (MetS). Endothelial function by flow-mediated dilation (FMD, by ultrasound) and arterial lesion by carotid intima media thickness (CIMT, by ultrasound) were also measured.
RESULTS: The mean age of participants was 16.8 ± 1.4 years. Obese adolescents had a body mass index of 32.7 ± 3.8 vs. 21.8 ± 2.1 in lean participants. The obesity group showed higher D-lactate levels: 6.2 ± 3.0 vs. 4.5 ± 2.5 μmol/L, higher levels of insulin: 15 (9.6-23.5) vs. 7.9 (6.5-10.5) μIU/mL; triglyceride (TG): 1.46 (1.1-1.8) vs. 0.84 (0.6-1.2) mmol/L; non-high-density lipoprotein-cholesterol (NON-HDL-C): 2.8 ± 0.9 vs. 2.3 ± 0.7 mmol/L; total cholesterol (TC)/HDL-C) index: 2.9 ± 0.7 vs. 2.4 ± 0.5; TG/HDL-C index: 2.2 (1.5-2.8) vs. 1.1 (0.8-1.8); %LDL-3: 4.2 ± 4.07 vs. 1.9 ± 2.7; smaller LDL size: 270.6 ± 3 vs. 272.2 ± 1.1 Å. D-lactate correlated positively with LDL-2: r = 0.44 and LDL-3 (sd-LDL): r = 0.49 and negatively with large LDL-1: r = -0.48 and LDL size: r = -0.46; (p<0.05, p<0.01, p<0.001 and p<0.0001, respectively). Obese adolescents showed higher CIMT: 0.51 ± 0.08 vs. 0.46 ± 0.08 mm and lower FMD: 20.3% ± 6.7% vs. 26.0% ± 9.3%.
CONCLUSIONS: Obese adolescents display subclinical signs of IR and endothelial dysfunction. Higher serum sd-LDL levels correlated positively with D-lactate levels. These findings suggest an association between atherogenic dyslipoproteinemia and whole body MG fluxes already detectable in apparently healthy obese adolescents.

DOI: 10.1515/cclm-2017-0733

PMID: 29447114 [Indexed for MEDLINE]

 

514. Acta Obstet Gynecol Scand. 2018 Oct;97(10):1267-1273. doi: 10.1111/aogs.13384. Epub 2018 Jun 22.

Assessment of lactate production as a response to sustained intrapartum hypoxia in large-for-gestational-age newborns.

Zaigham M(1), Källén K(2), Olofsson P(1).

Author information:

(1)Department of Obstetrics and Gynecology, Faculty of Medicine, Institution of Clinical Sciences Malmö, Skåne University Hospital, Lund University, Malmö, Sweden.

(2)Faculty of Medicine, Center for Reproductive Epidemiology, Tornblad Institute, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.

INTRODUCTION: Lactate concentration in umbilical cord blood is an important measure of intrapartum anaerobic metabolism. The aim of the study was to compare lactate production of large-for-gestational-age (LGA) fetuses against appropriate-for-gestational-age (AGA) fetuses during hypoxia, in diabetic and non-diabetic mothers.
MATERIAL AND METHODS: A total of 17 358 validated paired arterial and venous umbilical cord blood samples taken at birth with a full panel of pH, glucose, and lactate were analyzed relative to LGA (n = 2789) and AGA (n = 14 569). Umbilical cord blood acidemia (pH < mean minus 2 SD) was identified in 518 cases.
RESULTS: Diabetes, but not acidemia, was more common among LGA (5.4%) than AGA cases (2.9%) (respectively P < .0001 and P < .69). At normal pH, glucose was lower in non-diabetes LGA cases, but not in diabetes LGA compared with corresponding AGA cases (respectively P < .0001 and P < .067). Glucose levels were higher in all groups during acidemia (P ≤ .0005), with lower values in non-diabetes LGA but not in diabetes LGA compared with corresponding AGA cases (respectively P = .005 and P < .58). At normal pH, lactate was lower in non-diabetes LGA but not in diabetes LGA compared with corresponding AGA cases (respectively P < .0001 and P < .98); during acidemia, lactate levels were higher in all groups (P < .0001), resulting in no significant difference between LGA and AGA in diabetes as well as in non-diabetes cases (respectively P = .29 and P < .084).
CONCLUSIONS: Considering cord acidemia a proxy for intrapartum hypoxia, LGA fetuses showed no impaired ability to produce lactate during hypoxia. Maternal diabetes did not hamper the ability of LGA fetuses to produce lactate during hypoxia.

DOI: 10.1111/aogs.13384

PMCID: PMC6175007

PMID: 29786834 [Indexed for MEDLINE]

520. 
     Neurol Res. 2018 Oct;40(10):822-827. doi: 10.1080/01616412.2018.1484589. Epub 2018 Jun 18.

Neurological impairments in hypoxic neonates and lactate levels.

Jovandaric MZ(1), Milenkovic SJ(1).

Author information:

(1)a Department of Neonatology , Clinic for Gynecology and Obstetrics Clinical Center of Serbia , Belgrade , Serbia.

INTRODUCTION: Metabolic acidosis with increasing lactate concentration develops due to the lack of oxygen in the tissues.
OBJECTIVES: The effect of lactic acidosis on neurological development in the first year of life.
MATERIALS AND METHODS: Our study included 50 newborns with perinatal hypoxia requiring oxygen therapy and 50 healthy newborns. pH, pCO2, pO2, base excess (BE) and lactates from arterialized capillary blood were determined in both groups of newborns, in the first and second hours after birth, and neurological development in the first year of life was estimated.
RESULTS: pH, pCO2, pO2, BE and lactates differed significantly between the groups in the first and second hours after birth p < 0.01. Hypotonia was recorded in 20/50 cases and hypertonia was recorded in 10/50 cases in the first year of life.
CONCLUSION: Lactate concentration may be an indicator of neurological damage in neonates with perinatal hypoxia.

DOI: 10.1080/01616412.2018.1484589

PMID: 29912656 [Indexed for MEDLINE]

525. 
     Br J Anaesth. 2018 Aug;121(2):378-383. doi: 10.1016/j.bja.2018.04.039. Epub 2018 Jun 8.

Blood lactate concentration and shock index associated with massive transfusion in emergency department patients with primary postpartum haemorrhage.

Sohn CH(1), Kim YJ(1), Seo DW(1), Won HS(2), Shim JY(2), Lim KS(1), Kim WY(3).

Author information:

(1)Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea.

(2)Department of Obstetrics and Gynaecology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea.

(3)Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea. Electronic address: wonpia73@naver.com.

BACKGROUND: We hypothesised that lactate concentrations are independently associated with massive transfusion in patients with primary postpartum haemorrhage. Moreover, combining lactate concentrations with the shock index, defined as the ratio of heart rate to systolic arterial blood pressure, can improve the predictive performance for massive transfusion.
METHODS: We retrospectively analysed patients with primary postpartum haemorrhage in the emergency department of a tertiary referral centre in Korea between January 1, 2004 and December 31, 2015.
RESULTS: Of the 302 patients, 101 (33.4%) patients required massive transfusion. Lactate concentration was independently associated with the requirement for massive transfusion [odds ratio, 1.56; 95% confidence interval (CI), 1.31-1.87; P<0.01]. The area under the receiver operating characteristic curve of lactate concentration and shock index for massive transfusion was 0.788 (95% CI: 0.736-0.840; P<0.01) and 0.776 (95% CI: 0.717-0.836; P<0.01), respectively. Lactate elevation (>4.0 mM L-1) was associated with 86.1% specificity and 67.8%  positive predictive value for massive transfusion. When combining elevated lactate concentrations (>4.0 mM L-1) with a shock index >1.0, the specificity and positive predictive value increased to 95.5% and 82.4%, respectively.
CONCLUSIONS: Point-of-care testing of lactate concentrations in the emergency department may be useful to predict massive transfusion requirements in primary postpartum haemorrhage. Combining initial lactate concentrations with the shock index improves the predictive performance for massive transfusion requirements and may contribute to rapid risk stratification of patients with primary postpartum haemorrhage in need of transfusion and further focus on early interventions to control bleeding.

DOI: 10.1016/j.bja.2018.04.039

PMID: 30032876 [Indexed for MEDLINE]

528. 
     Psychiatry Clin Neurosci. 2018 Aug;72(8):546-555. doi: 10.1111/pcn.12671. Epub 2018 Jun

Lactate in bipolar disorder: A systematic review and meta-analysis.

Kuang H, Duong A, Jeong H(1), Zachos K(1), Andreazza AC(1).

Author information:

(1)Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada. The Authors. Psychiatry and Clinical Neurosciences 2018 Japanese - Society of Psychiatry and Neurology.

Bipolar disorder (BD) is a debilitating mood disorder with no specific biological marker. No novel treatment has been developed specifically for BD in the last several decades. Although the pathophysiology of BD remains unclear, there is strong evidence in the literature supporting the role of mitochondrial dysfunction in BD. In this systematic review, we identified and investigated 12 studies that measure lactate, which is a direct marker for mitochondrial dysfunction, in BD patients and healthy controls. Six studies measured lactate levels in the brain through proton echo-planar spectroscopy or magnetic resonance spectroscopy and five of these studies reported significantly elevated lactate levels in patients with BD. Two studies reporting cerebrospinal fluid lactate levels also found significantly elevated lactate in BD compared to healthy controls. Two other studies that reported peripheral lactate levels did not demonstrate significant findings. The meta-analysis, using standardized means and a random-effect model for five studies that measured brain lactate levels, corroborated the findings of the systematic review. Although the meta-analysis had a nearly significant overall effect (Z = 1.97, P = 0.05), high statistical heterogeneity (I2  = 86%) and possible publication bias suggest that the results should be interpreted with caution. To validate lactate abnormalities in BD, further studies should be carried out, including larger sample sizes, not excluding female patients, and using standardized methodologies. Peripheral lactate levels and other bioenergetic markers should be thoroughly studied to better understand the role of mitochondrial dysfunction in BD and to help develop more objective diagnostic tools.

DOI: 10.1111/pcn.12671

PMID: 29726068 [Indexed for MEDLINE]

529. 
     Scand J Trauma Resusc Emerg Med. 2018 Jun 5;26(1):47.doi: 10.1186/s13049-018-0510-5.

Capillary and venous lactate measurements with a handheld device compared to venous blood-gas analysis for emergency patients.

Stoll D(1), Englund E(2), Hillborg H(2), Vedin S(3), Larsson A(4).

Author information:

(1)Ambulance Services, Sundsvall Hospital, Västernorrland County Council, 851 86, Sundsvall, Sweden. David.stoll@lvn.se.

(2)Research and Development, Sundsvall Hospital, Västernorrland County Council, Sundsvall, Sweden.

(3)Ambulance Services, Sundsvall Hospital, Västernorrland County Council, 851 86, Sundsvall, Sweden.

(4)Karolinska Institutet, Department of Physiology and Pharmacology, Stockholm, Sweden.

BACKGROUND/AIM: Early identification of lactate levels may have a large impact on triage classification and assist in identifying critically ill patients. A handheld device provides a rapid and timesaving measurement of lactate levels adapted to work in a prehospital care setting. I.e., the device is small, fast, and easy-to-use. The aim of this study was to evaluate the Accutrend Plus handheld lactate analyzer in comparison to the reference in-hospital method.
METHODS: Patients triaged as minimum yellow according to the RETTS System (Rapid Emergency Triage and Treatment System) and transported to hospital by ambulance were selected and a written consent to participate was obtained prior to inclusion in the study. Capillary (CAP) and venous (VEN) blood were analyzed with Accutrend Plus (AP). Venous blood samples were analyzed at the local hospital laboratory (GEM premier 4000) within 20 min from sampling. All sampling was conducted by two registered nurses specially trained in prehospital care.
RESULTS: 480 lactate measurements were performed in 160 patients. The mean difference between measurements in capillary blood compared with the reference method was 0.7 mmol/L  and for venous blood 0.9 mmol/L. The limits of agreement from the Bland-Altman plot was - 0.9 to + 2.5 mmol/L and and - 0.1 to + 1.9 mmol/L, for CAP and VEN compared with GEM.
CONCLUSION: Our results shows low accuracy and low precision with VEN / CAPmeasurements of lactate compared to reference GEM.

DOI: 10.1186/s13049-018-0510-5

PMCID: PMC5987430

PMID: 29866138 [Indexed for MEDLINE]

530. 
     Am J Emerg Med. 2019 Mar;37(3):401-406. doi: 10.1016/j.ajem.2018.05.065. Epub 2018 Jun 2.

Blood lactate measurement within the emergency department: two-year retrospective analysis.

Contenti J(1), Occelli C(2), Lemoel F(2), Ferrari P(2), Levraut J(2).

Author information:

(1)Department of Emergency Medicine, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia Antipolis, Faculté de Médecine de Nice, Hopital Pasteur II, 30 Voie Romaine, F06000, France. Electronic address:

 (2)Department of Emergency Medicine, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia Antipolis, Faculté de Médecine de Nice, Hopital Pasteur II, 30 Voie Romaine, F06000, France.

We evaluate in this retrospective cohort, the clinical situations leading emergency physicians to take a blood lactate sample, the prevalence of hyperlactatemia and its impact on short-term adverse outcome. ED patients requiring a blood lactate measurement (BLM) during a two-year period were included. Early patients' outcomes were extracted and discharge diagnoses were classified into 12 diagnostic categories