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Background: The coexistence of sepsis and hematological malignancies increases patient vulnerability, revealing the need for precise prognostic markers. This study explores the prognostic significance of lactate levels and clearance in septic patients with hematological malignancies. Materials and methods: A retrospective cohort study from January 2016 to December 2019 in a tertiary hematological intensive care unit (ICU) included 167 adults with hematological malignancies and sepsis. The relationship between lactate levels, hyperlactatemia, lactate clearance, and ICU outcomes was investigated. ICU survivors and non-survivors were compared to identify the factors affecting ICU mortality. Results: Patients were primarily with lymphoma and acute leukemia (66%) and had frequent hyperlactatemia (64%) on ICU admission. ICU non-survivors demonstrated higher lactate levels and hyperlactatemia frequency at various time points (0, 6, and 12 h) than survivors. Lactate clearance and liver function tests did not differ significantly between the two groups. Invasive mechanical ventilation [OR (95% confidence interval-CI): 20.4 (2.4–79.8), p < 0.01], requirement of vasopressors [OR (95% CI): 5.6 (1.3–24.5), p < 0.01], lactate level at the 6th hour [OR (95% CI): 1.51 (1.1–2.07), p = 0.01], and APACHE II score (OR (95% CI): 1.16 (1.01–1.34), p = 0.05) were independent risk factors for ICU mortality. The Area Under the Curve for APACHE II score and lactate level at the 6th hour were 0.774 (95% CI: 0.682–0.866) and 0.703 (95% CI: 0.602–0.804), respectively. Conclusion: While elevated lactate levels correlate with mortality rate and lactate level at the 6th hour is an independent risk factor for mortality, the absence of a significant difference in lactate clearance challenges traditional assumptions. These results question the commonly accepted perspective regarding lactate dynamics in sepsis among individuals with hematological malignancies. Oral Presentation: İnci K, et al. "Hyperlactatemia, lactate clearance and outcome in critically ill patients with hematological malignancies," 22nd ınternational intensive care symposium, 2019. [ABSTRACT FROM AUTHOR]

Background and Objectives: Acute cardiorespiratory failure disrupts the delicate balance of energy supply, demand, and consumption, with elevated lactate levels and decreased blood pH serving as crucial indicators. Acute cardiogenic pulmonary edema (ACPO), a common cause of acute respiratory failure, poses a substantial mortality risk. Lactate, a byproduct of pyruvate reduction, is a pertinent marker in perfusion assessment. Lactate clearance (LC) has proven prognostic efficacy in various conditions but lacks consensus on its predictive power in acute cardiogenic pulmonary edema. Materials and Methods: This prospective observational study, conducted in a metropolitan area's third-level emergency department, involved patients with cardiogenic pulmonary edema from May 2021 to August 2023. The inclusion criteria specified acute cardiogenic pulmonary edema, excluding patients with incomplete data or other respiratory conditions. Lactate clearance, calculated at presentation and after 6 h, served as the primary outcome predictor. Our data analysis employed logistic regression, the ROC curve, and statistical tests. Results: The cohort of 106 patients revealed that a lactate clearance below 14.29% was significantly associated with mortality. While 51.6% of survivors were discharged, LC's predictive success for discharge was inconclusive. Logistic regression underscored the significance of lactate clearance, with a one-unit increase yielding a 5.55-fold probability of survival. The AUC for LC was 0.759. Conclusions: This study pioneers the exploration of lactate clearance in patients with acute cardiogenic pulmonary edema. LC below 14.29% signifies a poor prognosis, emphasizing its potential as an early treatment initiation marker. While acknowledging this study's limitations, we advocate for further multicenter research to refine the understanding of lactate clearance in this context. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hyperlactatemia has been recognized as a significant prognostic indicator in critically ill patients. Nonetheless, there remains a gap in understanding the specific risk factors contributing to increased mortality among undifferentiated emergency department (ED) patients presenting with elevated lactate levels. OBJECTIVES: The objective of the study is to investigate potential risk factors for 30-day in-hospital mortality in ED patients with hyperlactatemia. METHODS: All nontraumatic adult presentations to the ED who had a lactate level of ≥2.5 mmol/L were included. Comorbidities, vital signs, lactate levels, lactate clearance, lactate normalization, and final diagnosis were compared with 30-day in-hospital mortality. RESULTS: A 30-day in-hospital mortality rate of 10.4% was observed in 979 patients. The mortality rate was higher in hypotensive patients (odds ratio [OR] 4.973), in nursing home patients (OR 5.689), and bedridden patients (OR 3.879). The area under the curve for the second lactate level (0.804) was higher than the first lactate level (0.691), and lactate clearance (0.747) for in-hospital mortality. A second lactate level >3.15 mmol/l had a sensitivity of 81.3% in predicting in-hospital mortality. The OR for mortality was 6.679 in patients without lactate normalization. A higher mortality rate was observed in patients with acute renal failure (OR 4.305), septic shock (OR 4.110), and acute coronary syndrome (OR 2.303). CONCLUSIONS: A second lactate measurement more accurately predicts in-hospital mortality than lactate clearance and the first lactate level in ED patients. Nursing home patients, bed-ridden patients, hypotensive patients on initial ED presentation, patients without lactate normalization, and patients with a final diagnosis of acute renal failure, septic shock, and acute coronary syndrome had a higher mortality rate.

Abstract Among athletes, foam rolling is popular technique of myofascial release aimed to support recovery processes and counteract delayed onset muscle soreness. However, there is no consensus on the optimal parameters of the roller texture used in the procedure. The study aimed to determine whether using rollers with different textures and hardness (smooth/soft, grooved/mid, serrated/hard) in myofascial release affects post-exertional restitution rate and the level of perceived DOMS (Delayed Onset Muscle Soreness) after intense anaerobic exercise. The study involved 60 healthy and physically active men randomly divided into three experimental groups and one control group (passive rest)—each consisting of 15 individuals: STH—rolling with a smooth roller; G—rolling with a grooved roller; TP—rolling with a serrated roller; Pass—passive rest group. After performing a exercise test (one-minute high-intensity squat), blood lactate (LA), creatine kinase (CK) and pain perception (VAS Scale) were monitored. The analysis of the average LA concentration in the blood 30 min post-exercise showed a statistical difference for all rolling groups compared to the passive rest group: STH (p

BACKGROUND: Hyperlactatemia has been recognized as a significant prognostic indicator in critically ill patients. Nonetheless, there remains a gap in understanding the specific risk factors contributing to increased mortality among undifferentiated emergency department (ED) patients presenting with elevated lactate levels. OBJECTIVES: The objective of the study is to investigate potential risk factors for 30-day in-hospital mortality in ED patients with hyperlactatemia. METHODS: All nontraumatic adult presentations to the ED who had a lactate level of =2.5 mmol/L were included. Comorbidities, vital signs, lactate levels, lactate clearance, lactate normalization, and final diagnosis were compared with 30-day in-hospital mortality. RESULTS: A 30-day in-hospital mortality rate of 10.4% was observed in 979 patients. The mortality rate was higher in hypotensive patients (odds ratio [OR] 4.973), in nursing home patients (OR 5.689), and bedridden patients (OR 3.879). The area under the curve for the second lactate level (0.804) was higher than the first lactate level (0.691), and lactate clearance (0.747) for in-hospital mortality. A second lactate level >3.15 mmol/l had a sensitivity of 81.3% in predicting in-hospital mortality. The OR for mortality was 6.679 in patients without lactate normalization. A higher mortality rate was observed in patients with acute renal failure (OR 4.305), septic shock (OR 4.110), and acute coronary syndrome (OR 2.303). CONCLUSIONS: A second lactate measurement more accurately predicts in-hospital mortality than lactate clearance and the first lactate level in ED patients. Nursing home patients, bed-ridden patients, hypotensive patients on initial ED presentation, patients without lactate normalization, and patients with a final diagnosis of acute renal failure, septic shock, and acute coronary syndrome had a higher mortality rate. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Serial evaluations of lactate concentration may be more useful in predicting outcomes in patients with out-of-hospital cardiac arrest (OHCA) than a single measurement. This study aimed to evaluate the impact of lactate clearance (LC) on clinical and neurologic outcomes in patients with OHCA who underwent extracorporeal cardiopulmonary resuscitation (ECPR). DESIGN: Retrospective multicenter observational study. SETTING: Patients with OHCA receiving ECPR at 36 hospitals in Japan between January 1, 2013, and December 31, 2018. PATIENTS: This study evaluated 1227 patients, with lactateinitial assessed upon emergency department admission and lactatesecond measured subsequently. To adjust for the disparity in the time between lactate measurements, the modified 6-hour LC was defined as follows: ([lactateinitial--lactatesecond]/lactateinitial) x 100 x (6/the duration between the initial and second measurements [hr]). The patients were divided into four groups according to the modified 6-hour LC with an equivalent number of patients among LC quartiles: Q1 (LC < 18.8), Q2 (18.8 < LC < 59.9), Q3 (60.0 < LC < 101.2), and Q4 (101.2 < LC). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The 30-day survival rates increased as the 6-hour LC increased (Q1, 21.2%; Q2, 36.8%; Q3, 41.4%; Q4, 53.6%; p for trend < 0.001). In the multivariate analysis, the modified 6-hour LC was significantly associated with a 30-day survival rate (adjusted odds ratio [AOR], 1.003; 95% CI, 1.001-1.005; p < 0.001) and favorable neurologic outcome (AOR, 1.002; 95% CI, 1.000-1.004; p = 0.027). CONCLUSIONS: In patients with OHCA who underwent ECPR, an increase in the modified 6-hour LC was associated with favorable clinical and neurologic outcome. Thus, LC can be a criterion to assess whether ECPR should be continued. [ABSTRACT FROM AUTHOR]

Introduction: Lactate is a useful prognostic marker, as its level increases in hypoxic tissue and/or during accelerated aerobic glycolysis due to excessive beta-adrenergic stimulation and decreased lactate clearance. The Surviving Sepsis Campaign Bundle 2018 Update suggests premeasurement of lactate within 2–4 h so that physicians perform, assist, administer, and introduce lactate-guided resuscitation to reduce mortality due to sepsis. Methods: A total of 108 patients with septic shock who underwent continuous renal replacement therapy (CRRT) for acute kidney injury were enrolled in this observational study. Demographic, clinical, and laboratory data were collected, and patients were divided into two groups: survivors and non-survivors. Results: Multivariate analysis demonstrated that lactate levels at 24 h after initiation of CRRT treatment, but not lactate levels at intensive care unit (ICU) admission, were associated with mortality. Lactate clearance was associated with lower mortality among the survivors (OR = 0.140) at 6 h after ICU admission and late mortality (OR = 0.260) after 24 h. The area under the ROC curves for mortality was 0.682 for initial lactate; 0.797 for lactate at 24 h; and 0.816 for lactate clearance at 24 h. Conclusions: Our result reinforces that the determination of lactate dynamics represents a good predictor for mortality, and serial lactate measurements may be more useful prognostic markers than initial lactate in patients with septic shock. [ABSTRACT FROM AUTHOR]

Background: This investigation assesses the prognostic value of lactate levels and their clearance in septic shock patients, particularly emphasizing the comparative analysis between COVID-19 and non-COVID-19 patients in the emergency department. This study aims to elucidate the unique prognostic implications of lactate dynamics in these distinct patient groups, thereby enhancing the management of septic shock. Methods: An observational prospective study was conducted, enrolling 114 septic shock patients from the Emergency County Hospital Resita, Romania, categorizing them into COVID-19 and non-COVID-19 groups to examine their initial lactate levels, clearance rates, and their correlation with patient outcomes. Results: This study identified significant differences in the initial lactate levels and clearance rates between the two groups, indicating higher initial lactate levels and slower clearance rates in COVID-19 patients. Survivors demonstrated significantly lower initial lactate levels (1.5 ± 0.4 mmol/L) and higher lactate clearance rates (33 ± 15%) compared to non-survivors (2.5 ± 0.5 mmol/L and 24 ± 9%, respectively; lactate levels p = 0.001, clearance rates p = 0.002). Conclusions: Lactate monitoring, particularly clearance rates, is crucial in the prognostic assessment of septic shock patients. These findings highlight the need for targeted interventions in COVID-19 patients to improve outcomes, underscoring lactate dynamics as a vital component of septic shock management in differing patient populations. [ABSTRACT FROM AUTHOR]

Background: Magnesium (Mg) is crucial for normal mitochondrial function in human body. It functions as an important cofactor for numerous biological reactions involving ATP-generating enzymes such as mitochondrial ATP synthase and Na+/K+ ATPase. Method: This prospective, randomized, interventional study involving two groups of critically ill patients in ICU with hypomagnesaemia. One group received intravenous administration of magnesium sulphate while the second group received intravenous administration of placebo. Results: Comparison of serum lactate levels between cases and controls (n = 84) was statistically insignificant. Lactate clearance between cases and controls was comparable. Comparison of arterial blood gases between cases and controls was found to be statistically insignificant. Comparison of biochemical parameters between cases and controls. Hospital stay duration of cases and controls was found to be comparable. Mortality between cases and controls was comparable. Conclusion: There was a significant proportion of critically ill patients with serum hypomagnesemia however intravenous magnesium sulphate administration did not significantly affect the lactate clearance, the days on mechanical ventilation, duration of ICU stay or the mortality.

This pilot study aimed to evaluate the efficacy of the 4-h mean lactate clearance (LACclr) level as a predictive factor for in-hospital outcomes, 30-day mortality, and treatment success in patients with acute cardiogenic pulmonary edema (ACPE), a significant clinical form of acute heart failure (AHF).

Background: This investigation assesses the prognostic value of lactate levels and their clearance in septic shock patients, particularly emphasizing the comparative analysis between COVID-19 and non-COVID-19 patients in the emergency department. This study aims to elucidate the unique prognostic implications of lactate dynamics in these distinct patient groups, thereby enhancing the management of septic shock. Methods: An observational prospective study was conducted, enrolling 114 septic shock patients from the Emergency County Hospital Resita, Romania, categorizing them into COVID-19 and non-COVID-19 groups to examine their initial lactate levels, clearance rates, and their correlation with patient outcomes. Results: This study identified significant differences in the initial lactate levels and clearance rates between the two groups, indicating higher initial lactate levels and slower clearance rates in COVID-19 patients. Survivors demonstrated significantly lower initial lactate levels (1.5 ± 0.4 mmol/L) and higher lactate clearance rates (33 ± 15%) compared to non-survivors (2.5 ± 0.5 mmol/L and 24 ± 9%, respectively; lactate levels p = 0.001, clearance rates p = 0.002). Conclusions: Lactate monitoring, particularly clearance rates, is crucial in the prognostic assessment of septic shock patients. These findings highlight the need for targeted interventions in COVID-19 patients to improve outcomes, underscoring lactate dynamics as a vital component of septic shock management in differing patient populations.

Introduction: Lactate is a useful prognostic marker, as its level increases in hypoxic tissue and/or during accelerated aerobic glycolysis due to excessive beta-adrenergic stimulation and decreased lactate clearance. The Surviving Sepsis Campaign Bundle 2018 Update suggests premeasurement of lactate within 2–4 h so that physicians perform, assist, administer, and introduce lactate-guided resuscitation to reduce mortality due to sepsis. Methods: A total of 108 patients with septic shock who underwent continuous renal replacement therapy (CRRT) for acute kidney injury were enrolled in this observational study. Demographic, clinical, and laboratory data were collected, and patients were divided into two groups: survivors and non-survivors. Results: Multivariate analysis demonstrated that lactate levels at 24 h after initiation of CRRT treatment, but not lactate levels at intensive care unit (ICU) admission, were associated with mortality. Lactate clearance was associated with lower mortality among the survivors (OR = 0.140) at 6 h after ICU admission and late mortality (OR = 0.260) after 24 h. The area under the ROC curves for mortality was 0.682 for initial lactate; 0.797 for lactate at 24 h; and 0.816 for lactate clearance at 24 h. Conclusions: Our result reinforces that the determination of lactate dynamics represents a good predictor for mortality, and serial lactate measurements may be more useful prognostic markers than initial lactate in patients with septic shock.

Background: Upper gastrointestinal bleeding is a common presenting complaint in the emergency department (ED) and carries a small but significant mortality rate. In spite of the availability of various scoring systems, risk stratification for in hospital morbidity and mortality remains difficult. There is no single test that can reliably predict active bleeding from the upper gastrointestinal tract for use at primary health level. Aims and Objectives: To study the role of lactate clearance as a predictor of active bleeding and also to determine whether an ED arterial lactate can predict adverse outcomes like increased hospital length of stay, in hospital, 30-day and 60-day mortality. Methods and Material: Prospective single centre observational study at a tertiary hospital in north Kerala that included all stable adult patients who presented with the complaints of hematemesis, melena or both to the ED Arterial lactate was drawn at the bedside, a priori initial arterial lactate cut-off value of 2.2 mmol/L was selected and in patients with lactate value above the cut-off, a second lactate was measured to calculate lactate clearance. Results: Lactate clearance ≤13.39% was found to be associated with a high risk for active bleeding (odds ratio: 23.33; 95% CI = 4.337 to 125.512, P < 0.001). Optimal cut-off points for lactate as well as lactate clearance were derived using receiver operating characteristics curve. Conclusions: Lactate clearance can reliably rule in as well as rule out active bleeding in patients who might seem hemodynamically stable at the initial presentation to the ED.

In sepsis and septic shock, patients often face hemodynamic instability, resulting in fluid leakage, heightened capillary permeability, increased distribution volume, and compromised antimicrobial concentrations. Lactate clearance is a well-established marker of illness severity, particularly in the context of sepsis, where it serves as a reliable predictor of mortality. It is notably useful in the determination of resuscitation endpoints. This study aimed to compare lactate clearance within 6 hours between two meropenem dose groups. We conducted a secondary analysis of a randomized controlled trial involving participants aged 18 or older, diagnosed with sepsis and septic shock as per sepsis-3 criteria, and receiving meropenem in an emergency department (ED) setting. The study occurred between December 1, 2017, and August 31, 2018. Of 43 patients, 21 (48.84%) were in the high-dose meropenem group and 22 (51.16%) in the conventional-dose group. Remarkably, a significantly higher proportion of patients in the highdose group achieved lactate clearance greater than 10% within 6 hours compared to the conventional-dose group (95.2% vs. 63.6%, P=0.01). Lactate clearance greater than 10% at 3 days was 85.7% and 86.4% in the high-dose and conventional-dose groups, respectively (P=0.95). For 30-day mortality, there were 14.3% and 22.7% in the high-dose and conventional-dose groups, respectively (P=0.47). High-dose patients had 18.0 hospital-free days (range 0 to 24) versus 10.0 days (range 0 to 17.0) in the conventional-dose group (P=0.17). In summary, this study highlights a higher rate of sepsis and septic shock patients in the high-dose group achieving lactate clearance within 6 hours. This suggests potential benefits linked to the high-dose meropenem regimen for this specific group of patients. [ABSTRACT FROM AUTHOR]

Introduction: Lactate is a frequently used biomarker in emergency departments (EDs), especially in critically ill patients. The aim of this study is to investigate the relationship between lactate and lactate clearance with in-hospital mortality in unselected ED patients. Methods: This study was carried out retrospectively in the ED of a tertiary hospital. Patients aged 18 years and older whose blood lactate level was obtained in the ED were included in the study. Patients whose lactate value did not have sufficient analytical accuracy, whose lactate value was recorded in the system 180 minutes after admission, who were admitted to the ED as cardiac arrest, and whose ED or hospital outcome was unknown were excluded from the study. According to the first measured lactate value, the patients were divided into three groups: < 2.0mmol/L, 2.0-3.9mmol/L, and ≥ 4.0mmol/L. Lactate clearance was calculated and recorded in patients with one-to-four hours between two lactate values. Results: During the five-year study period, a total of 1,070,406 patients were admitted to the ED, of which 114,438 (10.7%) received blood gas analysis. The median age of 81,449 patients included in the study was 58 years (IQR: 30, min: 18–max: 117) and 54.4% were female. The study found that non-trauma patients with a lactate level between 2.0-3.9mmol/L had a 2.5-times higher mortality risk, while those with a lactate level of ≥ 4.0mmol/L had a 20.8-times higher risk, compared to those with a lactate level < 2.0mmol/L. For trauma patients, the mortality risk was three-times higher for those with lactate levels between 2.0-3.9mmol/L and nine-times higher for those with a lactate level of ≥ 4.0mmol/L, compared to those with a lactate level < 2.0mmol/L. Among patients with a first measured lactate value ≥ 4.0mmol/L and a two-hour lactate clearance < 20%, the mortality rate was 19.7%. In addition, lactate, lactate clearance, and age were independent variables for mortality in this patient group. Conclusion: The lactate value in unselected patients in the ED is a biomarker that can be used to predict the prognosis of the patients. In addition, lactate, lactate clearance, and age are independent predictors of mortality. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Despite advances in perioperative care, hepatectomy remains associated with morbidity rates of up to 40%. Currently, available nomograms for predicting severe post-hepatectomy complications do not include early postoperative data. This retrospective observational study aimed to determine whether the parameters routinely measured in patients admitted to the Intensive Care Unit (ICU) after hepatectomy could represent risk factors for severe morbidity and to propose a nomogram scoring system to predict severe postoperative complications. PATIENTS AND METHODS: 411 adult patients who underwent elective hepatectomy at a high-volume tertiary care center for hepatic surgery from December 2016 to June 2022 were enrolled. The primary outcome was the assessment of predictors of 30-day severe postoperative complications following hepatectomy, defined as Clavien-Dindo grade 3a or higher. As a secondary outcome, we aimed to develop an easy-to-use scoring system to estimate the risk of severe postoperative complications. RESULTS: Severe complications occurred in 78 patients (19%). The final model included body mass index, preoperative bilirubin level, and ICU data (i.e., pH, lactate clearance, arterial lactate concentration 12 hours after ICU admission, need for packed red blood cell transfusions, and length of stay). Notably, the latter three variables were proven to be independent predictors of the outcomes. The model showed an overall good fit (C-index=0.754, corrected Dxy=0.692). A calibration plot using bootstrap internal validity resampling confirmed the stability of the model (mean absolute error=0.017, root mean square error of approximation=0.00051). CONCLUSIONS: We developed an accurate and practical scoring system based on preoperative and early postoperative data to predict poor outcomes after hepatectomy. Further external validation on larger series could lead to the integration of such a tool in the routine clinical practice to support patients' management and early warning during ICU stay. [ABSTRACT FROM AUTHOR]

Abstract Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can be initiated during cardiac surgery or later in ICU according to the hemodynamic profile and organ perfusion. Our aim was to study the appropriate timing of post-cardiotomy ECMO (PC-ECMO) initiation. We retrospectively analyzed 152 adult patients supported with PC-ECMO in our cardiac center between 2016 and 2022. The patients were divided into two groups: the intra-operative ECMO and the postoperative ECMO groups. The primary outcome was all-and-on-ECMO hospital mortality. The secondary outcomes included ECMO duration, new need for dialysis, cerebrovascular stroke, and length of ICU stay. Results Our cohort analysis revealed that 81(53.3%) patients were intra-operatively supported with VA-ECMO while 71(46.7%) patients were postoperatively supported in ICU. The postoperative ECMO group had significantly lesser SAVE score (p = 0.001), higher SAVE risk classes (p < 0.001), and higher SOFA score (p = 0.008) compared to the intra-operative ECMO group. The postoperative ECMO group had significantly more frequent hospital mortality (p = 0.003), on-ECMO mortality (p = 0.006), cerebrovascular stroke (p = 0.034), acute renal failure requiring dialysis (p < 0.001), and lesser lactate clearance at 12 h (p = 0.016) and at 24 h (p = 0.023) compared to the intra-operative group. There were statistically insignificant differences between the two groups regarding post-ECMO hospital mortality, cerebral bleeding, limb ischemia, ECMO, and ICU duration. Postponed postoperative ECMO insertion was associated with an increased risk of death (HR 1.628, 95%CI 1.102–2.403, p =0.014) with cox-proportional hazard regression. Logistic multivariable regression showed that atrial fibrillation (OR 6.2, 95% CI 2.71–61.84, p = 0.002), initial SOFA score (OR 1.46, 95% CI 1.041–3.83, p = 0.001), and postoperative ECMO insertion (OR 1.93, 95% CI 1.04–8.73, p = 0.031) were the predictors of hospital mortality. Conclusions Postponed ECMO insertion in critically sick patients was associated with increased mortality after cardiac surgery. Early intra-operative initiation of PC-ECMO may have the potential to improve outcomes after cardiac surgeries.

Background and Objectives: Acute cardiorespiratory failure disrupts the delicate balance of energy supply, demand, and consumption, with elevated lactate levels and decreased blood pH serving as crucial indicators. Acute cardiogenic pulmonary edema (ACPO), a common cause of acute respiratory failure, poses a substantial mortality risk. Lactate, a byproduct of pyruvate reduction, is a pertinent marker in perfusion assessment. Lactate clearance (LC) has proven prognostic efficacy in various conditions but lacks consensus on its predictive power in acute cardiogenic pulmonary edema. Materials and Methods: This prospective observational study, conducted in a metropolitan area’s third-level emergency department, involved patients with cardiogenic pulmonary edema from May 2021 to August 2023. The inclusion criteria specified acute cardiogenic pulmonary edema, excluding patients with incomplete data or other respiratory conditions. Lactate clearance, calculated at presentation and after 6 h, served as the primary outcome predictor. Our data analysis employed logistic regression, the ROC curve, and statistical tests. Results: The cohort of 106 patients revealed that a lactate clearance below 14.29% was significantly associated with mortality. While 51.6% of survivors were discharged, LC’s predictive success for discharge was inconclusive. Logistic regression underscored the significance of lactate clearance, with a one-unit increase yielding a 5.55-fold probability of survival. The AUC for LC was 0.759. Conclusions: This study pioneers the exploration of lactate clearance in patients with acute cardiogenic pulmonary edema. LC below 14.29% signifies a poor prognosis, emphasizing its potential as an early treatment initiation marker. While acknowledging this study’s limitations, we advocate for further multicenter research to refine the understanding of lactate clearance in this context.

Background: We aimed to analyze the correlation between in-hospital mortality and hemodynamic changes, using polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) initiation time in patients with cancer with refractory septic shock. Methods: Forty-six patients with cancer who received PMX-DHP for refractory septic shock were retrospectively analyzed and classified into early (≤3 h between refractory septic shock and PMX-DHP; n = 17) and late (>3 h; n = 29) initiation groups. The vasopressor inotropic score (VIS), sequential organ failure assessment (SOFA) score, and lactate clearance before and 24 h post-PMX-DHP were compared. Results: Overall, 52.17% died from multiple organ dysfunction, with a lower mortality rate in the early initiation group. The VIS and SOFA score decreased in both groups, but the magnitude of decrease was not significant. Lactate clearance improved in both groups, with greater improvement in the early initiation group. Univariable analysis identified associations of in-hospital mortality with early initiation, ΔC-reactive protein, lactate clearance, ΔSOFA score, and ΔVIS. Multivariable analysis demonstrated associations of in-hospital mortality risk with ΔSOFA score and early PMX-DHP initiation. Overall survival was higher in the early initiation group. Early initiation of PMX-DHP in patients with cancer with refractory septic shock reduced in-hospital mortality and improved lactate clearance. [ABSTRACT FROM AUTHOR]

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can be initiated during cardiac surgery or later in ICU according to the hemodynamic profile and organ perfusion. Our aim was to study the appropriate timing of post-cardiotomy ECMO (PC-ECMO) initiation. We retrospectively analyzed 152 adult patients supported with PC-ECMO in our cardiac center between 2016 and 2022. The patients were divided into two groups: the intra-operative ECMO and the postoperative ECMO groups. The primary outcome was all-and-on-ECMO hospital mortality. The secondary outcomes included ECMO duration, new need for dialysis, cerebrovascular stroke, and length of ICU stay. Results: Our cohort analysis revealed that 81(53.3%) patients were intra-operatively supported with VA-ECMO while 71(46.7%) patients were postoperatively supported in ICU. The postoperative ECMO group had significantly lesser SAVE score (p = 0.001), higher SAVE risk classes (p < 0.001), and higher SOFA score (p = 0.008) compared to the intra-operative ECMO group. The postoperative ECMO group had significantly more frequent hospital mortality (p = 0.003), on-ECMO mortality (p = 0.006), cerebrovascular stroke (p = 0.034), acute renal failure requiring dialysis (p < 0.001), and lesser lactate clearance at 12 h (p = 0.016) and at 24 h (p = 0.023) compared to the intra-operative group. There were statistically insignificant differences between the two groups regarding post-ECMO hospital mortality, cerebral bleeding, limb ischemia, ECMO, and ICU duration. Postponed postoperative ECMO insertion was associated with an increased risk of death (HR 1.628, 95%CI 1.102–2.403, p =0.014) with cox-proportional hazard regression. Logistic multivariable regression showed that atrial fibrillation (OR 6.2, 95% CI 2.71–61.84, p = 0.002), initial SOFA score (OR 1.46, 95% CI 1.041–3.83, p = 0.001), and postoperative ECMO insertion (OR 1.93, 95% CI 1.04–8.73, p = 0.031) were the predictors of hospital mortality. Conclusions: Postponed ECMO insertion in critically sick patients was associated with increased mortality after cardiac surgery. Early intra-operative initiation of PC-ECMO may have the potential to improve outcomes after cardiac surgeries. [ABSTRACT FROM AUTHOR]

Background Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI) , and it is important to explore the efficacy of extracorporeal membrane oxygenation (ECMO) in AMI patients combined with CS.Objective To investigate the short-term prognostic value of early fluid balance and lactate clearance in AMI patients combined with CS treated with ECMO.Methods The clinical data of 49 hospitalized AMI patients combined with CS treated with ECMO from April 2017 to December 2022 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. The included patients were divided into the survival group (n=27) and death group (n=22) according to 30-day post-ECMO outcomes. Univariate and Multivariable Logistic regression analyses were used to evaluate the influencing factors of 30-day post-ECMO death. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of 24-h fluid balance, 24-h lactate clearance and their combination for 30-day post-ECMO outcomes. Delong test was used to compare the area under the ROC curve (AUC) .Results Age, creatinine level, the proportion of offender vessel as left main or left anterior descending branch, acute kidney injury and continuous renal replacement therapy, 24-h fluid balance, 24-h lactate with ECMO in the death group were higher than the survival group, and 24-h lactate clearance was lower than the survival group (P

Background: Abdominal normothermic regional perfusion (A‐NRP) allows in‐situ reperfusion and recovery of abdominal organs metabolism in donors after circulatory death (DCD). Besides improving liver transplantation outcomes, liver injury and function can be assessed during A‐NRP. Methods: To refine liver viability assessment during A‐NRP, prospectively collected data of controlled DCD donors managed at our Institution between October 2019 and May 2022 were retrospectively analyzed. Baseline characteristics, procedural variables and A‐NRP parameters of donors whose liver was successfully transplanted were compared to those of donors whose liver was discarded. Results: Twenty‐seven donors were included and in 20 (74%) the liver was accepted (positive outcome). No differences between study groups were observed concerning baseline characteristics and warm ischemia times (WIT). Initial lactate levels were positively correlated with functional WIT (r2 = 0.4, p = 0.04), whereas transaminase levels were not. Blood flow during A‐NRP was comparable, whereas oxygen consumption (VO2) was significantly higher in the positive outcome group after 1 h. Time courses of lactate, AST and ALT were significantly different between study groups (p < 0.001). Donors whose liver was accepted showed faster lactate clearance, a difference which was amplified by normalizing lactate clearance to oxygen delivery (DO2) and VO2. Lactate clearance was correlated to transaminase levels and DO2‐normalized lactate clearance was the parameter best discriminating between study groups. Conclusions: DO2‐normalized lactate clearance may represent an element of liver viability assessment during A‐NRP. [ABSTRACT FROM AUTHOR]

Abstract Background Tissue oxygen saturation (StO2) decrease could appear earlier than lactate alteration. However, the correlation between StO2 and lactate clearance was unknown. Methods This was a prospective observational study. All consecutive patients with circulatory shock and lactate over 3 mmol/L were included. Based on the rule of nines, a BSA (body surface area) weighted StO2 was calculated from four sites of StO2 (masseter, deltoid, thenar and knee). The formulation was as follows: masseter StO2 × 9% + (deltoid StO2 + thenar StO2) × (18% + 27%)/ 2 + knee StO2 × 46%. Vital signs, blood lactate, arterial and central venous blood gas were measured simultaneously within 48 h of ICU admission. The predictive value of BSA-weighted StO2 on 6-hour lactate clearance > 10% since StO2 initially monitored was assessed. Results A total of 34 patients were included, of whom 19 (55.9%) had a lactate clearance higher than 10%. The mean SOFA score was lower in cLac ≥ 10% group compared with cLac

Abstract Background Shock in children remains the primary cause of mortality and morbidity worldwide. Furthermore, its management outcome is improved using many hemodynamic parameters, such as cardiac power (CP) and lactate clearance (LC). Cardiac power is a contractility index based on the measurement of flow and pressure, and it is a relatively new hemodynamic parameter with limited studies. In contrast, LC has been proven useful as a target outcome in shock resuscitation. This study aims to explore the values of CP and LC in pediatric shock and their association with clinical outcomes. Methods This prospective observational study was conducted on children (1 month-18 years old) with shock at Cipto Mangunkusumo Hospital, Indonesia, from April to October 2021. We measured CP using ultrasonic cardiac output monitoring (USCOM®) and serum lactate levels at 0, 1, 6, and 24 h post-initial resuscitation. Subsequently, the variables were described and analyzed with the resuscitation success, length of stay, and mortality. Results A total of 44 children were analyzed. There were 27 (61.4%), 7 (15.9%), 4 (9.1%), 4 (9.1%), and 2 (4.5%) cases of septic, hypovolemic, cardiogenic, distributive, and obstructive shock, respectively. Within the first 24 h post-initial resuscitation, CP and LC had an increasing trend. Compared to children who had successful resuscitation, those who did not have successful resuscitation had similar CP at all time points (p > 0.05) and lower LC at 1 and 24 h post-initial resuscitation (p

Background: This study was conducted to test early resuscitation, targeting lactate levels as the marker of adequacy of oxygen delivery, compare the return of normal ScvO2 in predicting 7th day mortality, and compare the clearance of serum lactate (at least 10%) in predicting 7th day mortality. Methods: This was a hospital-based randomized prospective study conducted among 120 adult patients admitted to the medical ICU with septic shock at Rajarajeswari Medical College and Hospital from November 2015 to August 2017 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: 7th day mortality was 21.7% in group L and 33.3% in group S, the p-value was 0.152 which was not clinically significant between both groups. But lactate clearance in group L at 24 hours was 57.50±25.82 and at 72 hours was 76.87±14.80 which was clinically strongly significant and ScvO2 at mortality was around 70.6% but still there was a mortality of 33.3% on 7th day, which is higher compared to the lactate group. Conclusion: Goal-directed therapy provided at the initial stages of severe sepsis and septic shock has significant short term and longterm benefits. We can also say that using lactate as an indicator of sepsis will help in early diagnosis with risk stratification and repeated measurements at regular intervals can assist in the progress of treatment. [ABSTRACT FROM AUTHOR]

Objectives: Raised blood lactate levels are strongly associated with mortality in patients with cardiogenic shock. Recent practices of the early identification and initiation of mechanical circulatory support have improved outcomes in cardiogenic shock, but therapeutic targets to guide real-time clinical decision making are lacking. Recent evidence suggests that the degree and rate at which blood lactate levels decrease after the initiation of treatment is important in patient prognosis. With this background, lactate clearance has been suggested as a potential treatment target due to its independent association with morality. Materials and Methods: Lactate levels were measured at baseline and at 6, 12, and 24 h. Patients were grouped into survivors and non-survivors based on in-hospital mortality. Patients who had normal lactate (<2.0 mmoL/L) at baseline were excluded from the study. Statistical analysis done using appropriate tests. Results: Absolute lactate levels were compared between groups at baseline and 6, 12, and 24 h. Lactate clearance was calculated at 6, 12, and 24 h among survivors and non-survivors. In total, 90 patients were enrolled, and 65 (72.2%) of them survived to hospital discharge. Absolute blood lactate levels were 4.71 ± 1.36 mmoL/lit in survivors and 6.17 ± 2.88 mmoL/lit in non-survivors at baseline (P = 0.007). The mean lactate clearance at 6 h was 12.22 ± 85.96% in survivors and 12.98 ± 30.97% in non-survivors (P = 0.3). At 24 h, the mean lactate clearance was 54.63 ± 22.34% and 26.34 ± 19.3% in survivors and non-survivors, respectively (P < 0.01). Conclusion: Survivors had significantly greater lactate clearance at 12 and 24 h compared with non-survivors, suggesting that lactate clearance is an important prognostic marker in cardiogenic shock. These results further support the validity of lactate clearance as an appropriate surrogate for mortality and as a potential therapeutic target in clinical practice. Especially in centers lacking invasive hemodynamic monitoring. [ABSTRACT FROM AUTHOR]

Introduction: Mortality due to sepsis is increasing in the PICUs of India. This study was conducted with the aim to investigate the prognostic value of lactate level at the time of admission and lactate clearance for mortality in sepsis and estimate its cut-off value of predicting mortality. This study also aimed to estimate the correlation between lactate clearance with PRISM III score (Pediatric Risk of Mortality score) and duration of stay. Materials and Methods: This was a prospective study on 150 patients admitted with severe inflammatory response syndrome with a probable infection in the paediatric intensive care unit with an estimation of serial lactate levels in the blood at 0–3 h, 24 h and 48 h of admission. Lactate clearance was calculated, and patients were followed up till discharge/death. Results: Out of 150 patients, there were 94 survivors and 56 non-survivors; the mean lactate clearance at 24 h was 6.16% in non-survivors, which was lower than survivors at 28.41%. The cut-off value of lactate clearance for predicting mortality was estimated to be 17.6%. PRISM III score and lactate clearance were inversely related. The duration of intensive care unit stay was more in non-survivors with low lactate clearance. Conclusion: Lactate clearance can be used as a prognostic measure for mortality in patients with sepsis and can be used as a guide for treatment.

Abstract Background The mortality rate is high in critically ill patients due to the difficulty of diagnosis and treatment. Thus, it is very important to explore the predictive value of different indicators related to prognosis in critically ill patients. Methods This was a retrospective cohort study of patients in the intensive care unit (ICU) of the Sixth People’s Hospital in Shanghai, China. A total of 1465 ICU patients had lactate values > 2.1 mmol/L at least once within 24 h of ICU admission, and arterial blood gas was monitored more than twice during the ICU stay. Results The predictive value of lactate clearance at 24 h was not high, and the sensitivity and specificity were lower. The predictive value of the lactate level at baseline and the APACHE II score was higher than that of lactate clearance at 24 h in critically ill patients. The predictive value of the lactate level at baseline combined with the APACHE II score was higher than that of the lactate level at baseline or the APACHE II score alone. In addition, the predictive value of lactate clearance at 24 h combined with the APACHE II score was also significantly higher than that of lactate clearance at 24 h or the APACHE II score alone. In particular, the area under the ROC curve reached 0.900, the predictive value was markedly higher than that of the ROC alone, and the sensitivity and specificity were better when these three indicators were combined. Conclusions The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically ill patients.

Background Central blood gas and lactate levels serve as goals for fluid resuscitation.Objective To evaluate the role of blood gases [the ratio of P(v-a)CO2/C(a-v)O2 and P(v-a)CO2)] and lactate clearance as indicators of initial fluid resuscitation in patients diagnosed with sepsis.Study design This study included three groups of patients according to the resuscitation effective predictors.Patients A total of 120 patients were divided into 3 groups, 40 patients in each. Group (A): ratio P(v-a)CO2/C(a-v)O2, group (B):: of Lactate clearance (LC), and group (C): P(v-a)co2.Interventions Variables were measured at the start of ICU arrival (T0) and after 8 hours of resuscitation (T8).Main outcome measures The ratio P(v-a)CO2/C(a-v)O2, difference of P(v-a)co2 and Lactate level and clearance (LC) recorded and calculated, a dose of dobutamine required, packed RBCs, length of stay, mortality, and any recorded complication. Measured at T0 and T8 time pointsResults In group A, the ratio of P(v-a)CO2/C(a-v)O2 was improved significantly at T8 when compared with values at baseline. Lactate (group B) showed a significantly lower level at T8 than at T0. In group C, the gradient of P(v-a)CO2 did not differ significantly at T8. After 28 days, group C had a higher mortality rate (55% in group C vs 25% in group A and 30% in group B).Conclusion The ratio of P(v-a)CO2/C(a-v)O2 calculation may be as good as, if not better than, lactate as an indicator of initial resuscitation success of patients with sepsis, this can improve the outcome and reduce mortality. Unfortunately, the P(v-a)CO2 gradient alone is not

Abstract Background Traumatic hemorrhagic shock (THS) is the main cause of death in trauma patients with high mortality. Rapid control of the source of bleeding and early resuscitation are crucial to clinical treatment. Guidelines recommend isotonic crystal resuscitation when blood products are not immediately available. However, the selection of isotonic crystals has been controversial. Sodium bicarbonate Ringer solutions (BRS), containing sodium bicarbonate, electrolyte levels, and osmotic pressures closer to plasma, are ideal. Therefore, in this study, we will focus on the effects of BRS on the first 6 h of resuscitation, complications, and 7-day survival in patients with THS. Methods /design. This single-center, prospective, randomized controlled trial will focus on the efficacy and safety of BRS in early THS resuscitation. A total of 400 adults THS patients will be enrolled in this study. In addition to providing standard care, enrolled patients will be randomized in a 1:1 ratio to receive resuscitation with BRS (test group) or sodium lactate Ringer’s solution (control group) until successful resuscitation from THS. Lactate clearance at different time points (0.5, 1, 1.5, 3, and 6 h) and shock duration after drug administration will be compared between the two groups as primary end points. Secondary end points will compare coagulation function, temperature, acidosis, inflammatory mediator levels, recurrence of shock, complications, medication use, and 7-day mortality between the two groups. Patients will be followed up until discharge or 7 days after discharge. Discussion At present, there are still great differences in the selection of resuscitation fluids, and there is a lack of systematic and detailed studies to compare and observe the effects of various resuscitation fluids on the effectiveness and safety of early resuscitation in THS patients. This trial will provide important clinical data for resuscitation fluid selection and exploration of safe dose of BRS in THS patients. Trial registration. Chinese Clinical Trial Registry (ChiCTR), ChiCTR2100045044. Registered on 4 April 2021.

Background: Tissue oxygen saturation (StO2) decrease could appear earlier than lactate alteration. However, the correlation between StO2 and lactate clearance was unknown. Methods: This was a prospective observational study. All consecutive patients with circulatory shock and lactate over 3 mmol/L were included. Based on the rule of nines, a BSA (body surface area) weighted StO2 was calculated from four sites of StO2 (masseter, deltoid, thenar and knee). The formulation was as follows: masseter StO2 × 9% + (deltoid StO2 + thenar StO2) × (18% + 27%)/ 2 + knee StO2 × 46%. Vital signs, blood lactate, arterial and central venous blood gas were measured simultaneously within 48 h of ICU admission. The predictive value of BSA-weighted StO2 on 6-hour lactate clearance > 10% since StO2 initially monitored was assessed. Results: A total of 34 patients were included, of whom 19 (55.9%) had a lactate clearance higher than 10%. The mean SOFA score was lower in cLac ≥ 10% group compared with cLac < 10% group (11 ± 3 vs. 15 ± 4, p = 0.007). Other baseline characteristics were comparable between groups. Compared to non-clearance group, StO2 in deltoid, thenar and knee were significantly higher in clearance group. The area under the receiver operating curves (AUROC) of BSA-weighted StO2 for prediction of lactate clearance (0.92, 95% CI [Confidence Interval] 0.82-1.00) was significantly higher than StO2 of masseter (0.65, 95% CI 0.45–0.84; p < 0.01), deltoid (0.77, 95% CI 0.60–0.94; p = 0.04), thenar (0.72, 95% CI 0.55–0.90; p = 0.01), and similar to knee (0.87, 0.73-1.00; p = 0.40), mean StO2 (0.85, 0.73–0.98; p = 0.09). Additionally, BSA-weighted StO2 model had continuous net reclassification improvement (NRI) over the knee StO2 and mean StO2 model (continuous NRI 48.1% and 90.2%, respectively). The AUROC of BSA-weighted StO2 was 0.91(95% CI 0.75-1.0) adjusted by mean arterial pressure and norepinephrine dose. Conclusions: Our results suggested that BSA-weighted StO2 was a strong predictor of 6-hour lactate clearance in patients with shock. [ABSTRACT FROM AUTHOR]

Introduction: Mortality due to sepsis is increasing in the PICUs of India. This study was conducted with the aim to investigate the prognostic value of lactate level at the time of admission and lactate clearance for mortality in sepsis and estimate its cut-off value of predicting mortality. This study also aimed to estimate the correlation between lactate clearance with PRISM III score (Pediatric Risk of Mortality score) and duration of stay. Materials and Methods: This was a prospective study on 150 patients admitted with severe inflammatory response syndrome with a probable infection in the paediatric intensive care unit with an estimation of serial lactate levels in the blood at 0-3 h, 24 h and 48 h of admission. Lactate clearance was calculated, and patients were followed up till discharge/death. Results: Out of 150 patients, there were 94 survivors and 56 non-survivors; the mean lactate clearance at 24 h was 6.16% in non-survivors, which was lower than survivors at 28.41%. The cut-off value of lactate clearance for predicting mortality was estimated to be 17.6%. PRISM III score and lactate clearance were inversely related. The duration of intensive care unit stay was more in non-survivors with low lactate clearance. Conclusion: Lactate clearance can be used as a prognostic measure for mortality in patients with sepsis and can be used as a guide for treatment. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to compare the effects of active (AR) vs. passive recovery (PR) between two Wingate Anaerobic Tests (WAnT) on power output, blood lactate (BLa) and oxygen consumption (VO2) in a second WAnT. Methods: Twelve well-trained cyclists underwent three experimental sessions. In the first session, they completed an incremental test for maximum oxygen consumption (V O2max) and lactate threshold determination. In the second and third sessions, cyclists completed, in random order, two WAnT tests separated by 30-min recovery intervals, during which they performed an AR at 70% of the V O2 at lactate threshold (V O2LT) or a PR. The cardiorespiratory, metabolic, and mechanical responses in the two recovery conditions were compared. Results: No differences were found in the VO2-on kinetics between WAnT tests (p > 0.05). As expected, blood lactate kinetics showed a greater clearance (from the 7th to the 31st min, p 0.05). Mean and peak power, and total work were significantly higher in the second WAnT after AR (p

Abstract Background In patients with septic shock, the impact of the mean arterial pressure (MAP) target on the course of mottling remains uncertain. In this post hoc analysis of the SEPSISPAM trial, we investigated whether a low-MAP (65 to 70 mmHg) or a high-MAP target (80 to 85 mmHg) would affect the course of mottling and arterial lactate in patients with septic shock. Methods The presence of mottling was assessed every 2 h from 2 h after inclusion to catecholamine weaning. We compared mottling and lactate time course between the two MAP target groups. We evaluated the patient’s outcome according to the presence or absence of mottling. Results We included 747 patients, 374 were assigned to the low-MAP group and 373 to the high-MAP group. There was no difference in mottling and lactate evolution during the first 24 h between the two MAP groups. After adjustment for MAP and confounding factors, the presence of mottling ≥ 6 h during the first 24 h was associated with a significantly higher risk of death at day 28 and 90. Patients without mottling or with mottling

Abstract Background To develop a scoring system related to the lactate clearance (ΔLA) to predict the mortality risk (MELD-ΔLA) for critically ill cirrhotic patients. Methods In this retrospective cohort study, 881 critically ill cirrhotic patients from the Medical Information Mart for Intensive Care (MIMIC-III) database were included eventually. The outcomes of our study were defined as ICU death, 28-day, 90-day and 1-year mortality. Predictors were identified by multivariate Cox analysis to develop the predictive scoring system. The C-index and area under the curve (AUC) of receiver operator characteristic curve (ROC) were used to identify the predicting performance of the MELD-ΔLA, sequential organ failure assessment (SOFA), chronic liver failure-sequential organ failure assessment (CLIF-SOFA), the model for end-stage liver disease (MELD), Child–Pugh, chronic liver failure consortium acute-on-chronic liver failure (CLIF-C ACLF), chronic liver failure consortium-acute decompensation (CLIF-C AD) and MELD-Na scoring systems. Additionally, subgroup analysis was also performed based on whether critically ill cirrhotic patients underwent liver transplantation. Results Creatinine, bilirubin, international normalized ratio (INR), lactate first, ΔLA and vasopressors were closely associated with ICU death of liver critically ill cirrhotic patients. The C-index of the MELD-ΔLA in ICU death was 0.768 (95% CI 0.736–0.799) and the AUC for the MELD-ΔLA scoring system in predicting 28-day, 90-day, and 1-year mortality were 0.774 (95% CI 0.743–0.804), 0.765 (95% CI 0.735–0.796), and 0.757 (95% CI 0.726–0.788), suggested that MELD-ΔLA scoring system has a good predictive value than SOFA, CLIF-SOFA, MELD, Child–Pugh, CLIF-C ACLF, CLIF-C AD) and MELD-Na scoring systems. Additionally, the study also confirmed the good predictive value of MELD-ΔLA scoring system for critically ill cirrhotic patients regardless of undergoing liver transplantation. Conclusion The developed MELD-ΔLA score is a simple scoring system in predicting the risk of ICU death, 28-day, 90-day and 1-year mortality for critically ill cirrhotic patients, which may have a good predictive performance.

PurposePrevious studies have revealed that elevated mean central venous pressure (CVP) was associated with poor prognosis in specific patient groups. But no study explored the impact of mean CVP on prognosis of patients who underwent coronary artery bypass grafting surgery (CABG). The purpose of this study was to investigate the impacts of elevated CVP and its time-course on clinical outcomes of patients who underwent CABG and potential mechanisms.MethodsA retrospective cohort study was performed based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We first identified the CVP during specific period with the most predictive value. Patients were categorized into the low-CVP and high-CVP group on the basis of the cut-off value. A propensity score matching was used to adjust covariates. The primary outcome was a 28-day mortality. The secondary outcomes were 1-year mortality and in-hospital mortality, the length of intensive care unit (ICU) stay and hospitalization, acute kidney injury incidence, use of vasopressors, duration of ventilation and oxygen index, and lactate levels and clearance. Patients in the high-CVP group were categorized into the “second day CVP ≤ 13.46 mmHg” group and the “second day CVP > 13.46 mmHg” group, respectively, and the clinical outcomes were the same as before.ResultsA total of 6,255 patients who underwent CABG were picked from the MIMIC-IV database, of which 5,641 CABG patients were monitored by CVP measurement during the first 2 days after ICU admission and 206,016 CVP records were extracted from the database. The mean CVP during the first 24 h was the most correlative and statistically significant for the 28-day mortality. The risk of the 28-day mortality was increased in the high-CVP group [OR 3.45 (95% CI: 1.77–6.70; p

Background: High ratio of the carbon dioxide veno-arterial difference to the oxygen arterial-venous difference (PvaCO2/CavO2) is associated with fluid bolus (FB) induced increase in oxygen consumption (VO2). This study investigated whether PvaCO2/CavO2 was associated with decreases in blood-lactate levels FB in critically ill patients with hyperlactatemia. Methods: This prospective observational study examined adult patients in the intensive care unit (ICU) with lactate levels > 1.5 mmol/L who received FBs. Blood-lactate levels were measured before and after FB under unchanged metabolic, respiratory, and hemodynamic conditions. The primary outcome was blood-lactate levels after FB. Significant decreases in blood-lactate levels were considered as blood-lactate levels < 1.5 mmol/L or a decrease of more than 10% compared to baseline. Results: The study enrolled 40 critically ill patients, and their median concentration of blood lactate was 2.6 [IQR:1.9 − 3.8] mmol/L. There were 27 (68%) patients with PvaCO2/CavO2 ≥ 1.4 mmHg/ml, and 10 of them had an increase in oxygen consumption (dVO2) ≥ 15% after FB, while 13 (32%) patients had PvaCO2/CavO2 < 1.4 mmHg/ml before FB, and none of them had dVO2 ≥ 15% after FB. FB increased the cardiac index in patients with high and low preinfusion PvaCO2/CavO2 (13.4% [IQR: 8.3 − 20.2] vs. 8.8% [IQR: 2.9 − 17.4], p = 0.34). Baseline PvaCO2/CavO2 was not found to be associated with a decrease in blood lactate after FB (OR: 0.88 [95% CI: 0.39 − 1.98], p = 0.76). A positive correlation was observed between changes in blood lactate and baseline PvaCO2/CavO2 (r = 0.35, p = 0.02). Conclusions: In critically ill patients with hyperlactatemia, PvaCO2/CavO2 before FB cannot be used to predict decreases in blood-lactate levels after FB. Increased PvaCO2/CavO2 is associated with less decrease in blood-lactate levels. [ABSTRACT FROM AUTHOR]

Background: The mortality rate is high in critically ill patients due to the difficulty of diagnosis and treatment. Thus, it is very important to explore the predictive value of different indicators related to prognosis in critically ill patients. Methods: This was a retrospective cohort study of patients in the intensive care unit (ICU) of the Sixth People's Hospital in Shanghai, China. A total of 1465 ICU patients had lactate values > 2.1 mmol/L at least once within 24 h of ICU admission, and arterial blood gas was monitored more than twice during the ICU stay. Results: The predictive value of lactate clearance at 24 h was not high, and the sensitivity and specificity were lower. The predictive value of the lactate level at baseline and the APACHE II score was higher than that of lactate clearance at 24 h in critically ill patients. The predictive value of the lactate level at baseline combined with the APACHE II score was higher than that of the lactate level at baseline or the APACHE II score alone. In addition, the predictive value of lactate clearance at 24 h combined with the APACHE II score was also significantly higher than that of lactate clearance at 24 h or the APACHE II score alone. In particular, the area under the ROC curve reached 0.900, the predictive value was markedly higher than that of the ROC alone, and the sensitivity and specificity were better when these three indicators were combined. Conclusions: The combination of lactate level, lactate clearance and APACHE II score better predicts short-term outcomes in critically ill patients. [ABSTRACT FROM AUTHOR]

Central blood gas and lactate levels serve as goals for fluid resuscitation. To evaluate the role of blood gases [the ratio of P(v-a)CO2/C(a-v)O2 and P(v-a)CO2)] and lactate clearance as indicators of initial fluid resuscitation in patients diagnosed with sepsis. This study included three groups of patients according to the resuscitation effective predictors. A total of 120 patients were divided into 3 groups, 40 patients in each. Group (A): ratio P(v-a)CO2/C(a-v)O2, group (B):: of Lactate clearance (LC), and group (C): P(v-a)co2. Variables were measured at the start of ICU arrival (T0) and after 8 hours of resuscitation (T8). The ratio P(v-a)CO2/C(a-v)O2, difference of P(v-a)co2 and Lactate level and clearance (LC) recorded and calculated, a dose of dobutamine required, packed RBCs, length of stay, mortality, and any recorded complication. Measured at T0 and T8 time points In group A, the ratio of P(v-a)CO2/C(a-v)O2 was improved significantly at T8 when compared with values at baseline. Lactate (group B) showed a significantly lower level at T8 than at T0. In group C, the gradient of P(v-a)CO2 did not differ significantly at T8. After 28 days, group C had a higher mortality rate (55% in group C vs 25% in group A and 30% in group B). The ratio of P(v-a)CO2/C(a-v)O2 calculation may be as good as, if not better than, lactate as an indicator of initial resuscitation success of patients with sepsis, this can improve the outcome and reduce mortality. Unfortunately, the P(v-a)CO2 gradient alone is not [ABSTRACT FROM AUTHOR]

Background In septic shock patients with cirrhosis, impaired liver function might decrease lactate elimination and produce a higher lactate level. This study investigated differences in initial lactate, lactate clearance, and lactate utility between cirrhotic and non-cirrhotic septic shock patients. Methods This is a retrospective cohort study conducted at a referral, university-affiliated medical center. We enrolled adults admitted during 2012–2018 who satisfied the septic shock diagnostic criteria of the Surviving Sepsis Campaign: 2012. Patients previously diagnosed with cirrhosis by an imaging modality were classified into the cirrhosis group. The initial lactate levels and levels 6 hours after resuscitation were measured and used to calculate lactate clearance. We compared initial lactate, lactate at 6 hours, and lactate clearance between the cirrhosis and non-cirrhosis groups. The primary outcome was in-hospital mortality. Results Overall 777 patients were enrolled, of whom 91 had previously been diagnosed with cirrhosis. Initial lactate and lactate at 6 hours were both significantly higher in cirrhosis patients, but there was no difference between the groups in lactate clearance. A receiver operating characteristic curve analysis for predictors of in-hospital mortality revealed cut-off values for initial lactate, lactate at 6 hours, and lactate clearance of >4 mmol/L, >2 mmol/L, and 5 mmol/L, >5 mmol/L, and

Thanya Limapichat, Krittapat Pattanapong Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, ThailandCorrespondence: Thanya LimapichatDepartment of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, ThailandTel +66 74-451705Fax +66 74-451704Email thanya_nl@yahoo.comObjective: To compare the effect of isotonic crystalloid solutions between lactated Ringer’s solution (LRS) and normal saline solution (NSS) on lactate clearance in septic patients at the emergency department (ED).Materials and Methods: This study is a single-center retrospective chart review. The study enrolled patients older than 18 years with sepsis and initial serum lactate level > 2 mg/dL in the ED. The primary outcome was to determine which isotonic solution was better for serum lactate clearance in septic patients. The secondary outcomes were serum creatinine change within 24 h and the 48-h survival rate after admission.Results: A total of 120 patients were enrolled with a median crystalloid volume administered in the ED of 1000 mL. Within 2 h of resuscitation, there was no difference in lactate clearance between the LRS and NSS groups with median values of 29.2% and 25%, respectively (P=0.839). The 48-h survival rate after admission did not differ between the LRS and NSS groups with median values of 90% and 86%, respectively. Both isotonic solutions increased serum creatinine levels within 24 h of treatment with median values of 0.3 for each group (P=0.647).Conclusion: Among septic patients in the ED treated with NSS or LRS, there was no difference in lactate clearance, serum creatinine change within 24 h, or 48-h survival. However, several factors were associated with increased lactate levels, such as older age and use of vasopressors and immunosuppressive agents.Keywords: lactate clearance, balance crystalloid, sepsis, NEWS

Objective: To compare the accuracy of serum lactate parameters, including lactate peak concentration (LACpeak), lactate time area (LACarea), and lactate clearance (LC) for predicting mortality of the septic patients, and to compare with the predictive accuracy of National Early Warning Score (NEWS) and Sequential Organ Failure Assessment (SOFA) scores. Methods: This study retrospectively screened the septic patients admitted to the ICU in the Medical Information Mart for Intensive Care IV (MIMIC-IV) from 2008 to 2019. The baseline data and outcomes of patients were gathered. The subjects were divided into the non-survival group and the survival group. SOFA, NEWS, LACpeak, and LACarea were recorded. The LC was calculated 6 h after LACpeak. The above parameters were compared by the T-test and Mann-Whitney U test, and odds ratios were calculated adjusting for age and sex. The receiver operating characteristic curves (ROCs) of subjects were plotted according to SOFA, NEWS, LACpeak, and LACarea within 24h, and LC at 6h of ICU admission. The Areas under the ROC curve (AUCs), sensitivity, and specificity were compared with R version 4.1.1. Results: 1,169 septic patients were involved, and 366 (31.3%) patients died within 28 days. Compared to the survival group, the LACpeak of the non-survival group was higher [4.85 (3.2, 7.9) vs. 3.4 (2.6, 5.25) mmol/L, adjusted odds ratio 1.18, P < 0.001], and the LACarea of the non-survivals was higher than the survivals too [18.44 (10.36, 27.63) vs. 13.65 (9.01, 21.73), adjusted odds ratio 1.03, P < 0.001)]. The LC of the survivals at 6 h after LACpeak was significantly higher than that of the non-survivals [0.26 (0.14.0.42) vs. 0.19 (0.10, 0.33), adjusted odds ratio 0.06, P < 0.01]. Within 24h of ICU admission, the AUCs of mortality prediction in descending order were NEWS [0.73 (0.70, 0.76)], SOFA [0.69 (0.66, 0.73)], LACpeak [0.64 (0.61, 0.68)], and LACarea [0.60 (0.56, 0.63)]. There were 204 patients with 6-hour LC after LACpeak the AUCs of LACarea, LACpeak and LC were 0.73(0.65, 0.80), 0.71(0.62,0.78) and 0.65 (0.56, 0.73), respectively. Conclusions: The predictive accuracy of LC was not superior to LACpeak and LACarea for the mortality of the septic patients and the predictive value of all the above lactate parameters for mortality maybe not better than SOFA and NEWS.

Background/aim: Hyperlactatemia is a common finding in critically ill patients and has significant prognostic implications. However, a single lactate measurement has not been correlated to mortality consistently. In this study, we aimed to correlate the clinical efficacy of lactate clearance for the prediction of mortality in pediatric intensive care unit patients. Materials and methods: This retrospective observational study was performed in the pediatric intensive care unit in patients with lactate level >3 mmol/lt. Initial, 6th h, and 24th h lactate levels were recorded and lactate clearance was calculated using these values (lactate level at admission -- level 6 h later x 100/lactate level at admission). Results: A total of 172 patients were included in the study. Forty-four out of 172 patients died. Median (IQR) lactate (mmol/L) at admission was low in those who survived in comparison to nonsurvivors 4.4 (3.1) vs. 5.75 (7.7) (p = 0.002). Clearance at 6th h was significantly lower in those who died (11.7%) than those who survived (36.7) (p = 0.001). 6th h lactate clearance level <20.7% predicted mortality with a sensitivity of 63.6% and specificity of 69.5% along with a positive predictive value of 41.8 and a negative predictive value of 84.8 (p = 0.004). Both lactate levels and lactate clearance values were significantly predictive factors for mortality (p < 0.05). Only a positive moderate correlation was found between the percentage of PRISM-IV % and 6th h lactate level. Conclusion: The present study revealed that lactate clearance is a simple and rapid risk-stratification tool holding to be a potential biomarker of managing the treatment efficacy of children in the pediatric intensive care unit. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of Shenfu Injection (参附注射液, SFI) on blood lactate, and secondarily its effect on the lactate clearance (LC) in patients with post cardiac arrest syndrome (PCAS). Methods: The present study is a post hoc study of a randomized, assessor-blinded, controlled trial. Patients experienced in-hospital cardiac arrest between 2012 and 2015 were included in the predefined post hoc analyses. Of 1,022 patients enrolled, a total of 978 patients were allocated to the control group (486 cases) and SFI (492 cases) group, receiving standardized post-resuscitation care bundle (PRCB) treatment or PRCB combined with SFI (100 mL/d), respectively. Patients' serum lactate was measured simultaneously with artery blood gas, lactate clearance (LC) was calculated on days 1, 3, and 7 after admission and compared between groups. Lactate and LC were also compared between the survivors and non-survivors according to the 28-d mortality, as well as the survivors and non-survivors subgroups both in the SFI and control groups. Results: In both groups, compared with pre-treatment levels, mean arterial pressure (MAP) and PaO2 were significantly improved on 1, 3, 7 d after treatment (P<0.05), while heart rate (HR) and blood glucose levels were significantly decreased on 1, 3 and 7 d after treatment (P<0.05). compared with control group, SFI treatment improved the values of MAP and PaO2 (P<0.05), and significantly decreased the levels of HR and the blood glucose level on 3 and 7 d after treatment (P<0.05). Compared with the control group, lactate levels decreased faster in the SFI group versus the control group on 3 and 7 d (P<0.05). From initiation of treatment and the following 3 and 7 d, SFI treatment greatly increased the LC compared with that in the control group (P<0.05). Compared with survivors, non-survivors had higher admission lactate levels (7.3 ±1.1 mmol/L vs. 5.5 ±2.3 mmol/L; P<0.01), higher lactate levels on days 1, 3 and 7 (P<0.05), and LC were decreased significantly on 3 and 7 d after treatment (P<0.05). Similar results were also found both in the SFI and control groups between survivors and non-survivors subgroups. Conclusion: SFI in combination with PRCB treatment is effective at lowering lactate level and resulted in increasing LC in a targeted population of PCAS patients. [ABSTRACT FROM AUTHOR]

Background: Traumatic hemorrhagic shock (THS) is the main cause of death in trauma patients with high mortality. Rapid control of the source of bleeding and early resuscitation are crucial to clinical treatment. Guidelines recommend isotonic crystal resuscitation when blood products are not immediately available. However, the selection of isotonic crystals has been controversial. Sodium bicarbonate Ringer solutions (BRS), containing sodium bicarbonate, electrolyte levels, and osmotic pressures closer to plasma, are ideal. Therefore, in this study, we will focus on the effects of BRS on the first 6 h of resuscitation, complications, and 7-day survival in patients with THS.Methods: /design. This single-center, prospective, randomized controlled trial will focus on the efficacy and safety of BRS in early THS resuscitation. A total of 400 adults THS patients will be enrolled in this study. In addition to providing standard care, enrolled patients will be randomized in a 1:1 ratio to receive resuscitation with BRS (test group) or sodium lactate Ringer's solution (control group) until successful resuscitation from THS. Lactate clearance at different time points (0.5, 1, 1.5, 3, and 6 h) and shock duration after drug administration will be compared between the two groups as primary end points. Secondary end points will compare coagulation function, temperature, acidosis, inflammatory mediator levels, recurrence of shock, complications, medication use, and 7-day mortality between the two groups. Patients will be followed up until discharge or 7 days after discharge.Discussion: At present, there are still great differences in the selection of resuscitation fluids, and there is a lack of systematic and detailed studies to compare and observe the effects of various resuscitation fluids on the effectiveness and safety of early resuscitation in THS patients. This trial will provide important clinical data for resuscitation fluid selection and exploration of safe dose of BRS in THS patients.Trial Registration: Chinese Clinical Trial Registry (ChiCTR), ChiCTR2100045044. Registered on 4 April 2021. [ABSTRACT FROM AUTHOR]

Background: This study investigated the association of the Survival After VA-ECMO (SAVE) score, Sequential Organ Failure Assessment (SOFA) score, and post-cannulation lactate levels with mortality among patients treated with veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (CS)., Methods: We performed a retrospective review of adult patients who underwent peripheral VA-ECMO cannulation from January 2018 to September 2022 at a quaternary care center. All-cause in-hospital mortality was assessed and compared to predicted mortality by SAVE and SOFA scores prior to cannulation, with adjusted odds ratio of risk factors for mortality identified by multivariate logistic regression analysis. Additionally, the prognostic value of 8-h post-cannulation serum lactate levels was analyzed by receiver operating characteristic (ROC) curve and Kaplan Meier analysis of 30-day survival., Results: 244 patients were included in final analysis. All-cause in-hospital mortality was 70 %, and 54 % of patients died while on ECMO or within 24 h of decannulation. Pre-cannulation SAVE score (OR 0.93 per unit increase, 95 % CI 0.86-0.99, p = 0.008), SOFA score (OR 1.54 per unit increase, 95 % CI 1.32-1.75), and 8-h post-cannulation lactate levels (OR 1.20 per mmol/L increase, 95 % CI 1.04-1.36, p = 0.008) were independently associated with all-cause in-hospital mortality. 8-h post-cannulation lactate levels ≥5.3 mmol/L demonstrated high specificity for in-hospital mortality (90.0 %), while levels ≥7.8 mmol/L were demonstrated high specificity for VA-ECMO death (91.1 %). These thresholds were significantly associated with 30-day all-cause mortality (p < 0.001)., Conclusion: Pre-cannulation SAVE and SOFA scores are useful prognostic tools in patients with CS. 8-h post-cannulation serum lactate levels are a pragmatic biomarker and can further assist in prognostication of patients on VA-ECMO, and the cutoffs of 5.3 mmol/L and 7.8 mmol/L have high specificity for all-cause mortality and VA-ECMO mortality, respectively. The development of accurate prognostic tools is critical in managing and optimizing care for patients with CS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)