Association between serum lactate levels and enteral feeding intolerance in septic patients treated with vasopressors: a retrospective cohort study

Abstract

Background: To assess the association between serum lactate levels and intolerance to enteral nutrition (EN) in septic patients treated with vasopressors.Methods: This retrospective study was conducted between January 1, 2015 and May 1, 2018 in an intensive care unit (ICU). Patients with sepsis who were given EN and treated with vasopressors were included.EmpowerStats software and R (version 3.3.2) was used to examine the association between serum lactate levels and intolerance to EN.Results: Among the 132 septic patients (age, 60.6±18.1 years) enrolled, 35 (26.5%) patients suffered intolerance to EN. Multiple logistic regression analysis demonstrated that an elevated lactate level was an independent risk factor for EN intolerance [odds ratio (OR): 2.7; 95% confidence interval (CI): 1.6-4.4; P<0.001]. The area under the receiver operating characteristic (ROC) curve for serum lactate levels was 0.764 (95% CI: 0.664-0.864). Stratified analysis suggested that age was the most prominent interactive factor for serum lactate levels in EN intolerance. Serum lactate levels were closely correlated to EN intolerance in elderly patients (age ≥65 years) (OR: 9.5; 95% CI: 2.1-42.4; P=0.0261 for interaction), while no such association was identified in younger patients (age <65 years; OR: 1.7; 95% CI: 1.0-2.9; P=0.052).Conclusions: Serum lactate levels were associated with an increased risk of EN intolerance in patients with sepsis, especially in elderly individuals. An elevated serum lactate level may be an early predictor of EN intolerance in elderly septic patients treated with vasopressors. However, further studies are called for to verify these findings.

Development and validation of a predictive model for feeding intolerance in intensive care unit patients with sepsis

“…Mao et al . [ 11 ] showed that elevated serum lactate levels were more likely to be associated with FI development in the elderly patients with sepsis treated with vasopressors. The patients with septic shock who receive adequate fluid resuscitation and receive norepinephrine doses of <0.14 μg/kg/min may tolerate early EN.…”

“…Based on previous studies,[ 4 5 7 8 9 10 11 ] the collected exposure data included information on demographics (age and sex), medical history (hypertension, diabetes, coronary heart disease, kidney failure, chronic obstructive pulmonary disease, cerebrovascular accident), infection site, clinical presentation, laboratory results on admission (albumin, creatinine, urea nitrogen), disease severity (Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score), clinical treatment (sedation, analgesia, antibiotics, continuous feeding), EN type (short peptides, intact protein), and patient outcomes. All exposure data were collected from the database of electronic medical records and laboratory test reports.…”

Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study

“…The most likely diagnosis and the mechanism underlying the development of clinical symptoms were recurrences of nephrotic syndrome secondary to de novo formation of anti-nephrin antibodies [39] . Moreover, serum lactate levels were reportedly associated with an increased risk of EN FI, [40] while lactic acidosis is very common in patients with acidosis who require CRRT. Elevated serum lactate levels indicate the presence of hypoxia in tissues and GI dysfunction in patients with hemodynamic instability, which further affects their tolerance to EN.…”

Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China

“…The studies included 10 prospective studies [ [114] , [115] , [116] , [117] , [118] , [119] , [120] , [121] , [122] , [123] ] and 16 retrospective studies. [ [124] , [125] , [126] , [127] , [128] , [129] , [130] , [131] , [132] , [133] , [134] , [135] , [136] , [137] , [138] , [139] ] The overall incidence rate of feeding intolerance in critically ill patients was found to be 0.40 (95% CI: 0.34 to 0.46), indicating a substantial association with adverse patient-centered outcomes. Particularly noteworthy is the OR for all-cause ICU mortality risk, which was 1.99 (95% CI: 1.69 to 2.35).…”