Differentiating hyperlactatemia type A from type B: How does the lactate/pyruvate ratio help?

Redant, Sébastien; Hussein, Hamda; Mugisha, Aude; Attou, Rachid; Bels, David De; Honoré, Patrick M.; Laet, Corinne C. De

doi:10.2478/jtim-2019-0010

Cited by 18 publications

(14 citation statements)

References 17 publications

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“…Type A lactic acidosis is caused by tissue hypoperfusion or acute severe hypoxemia; type B is due to toxin-induced impairment of cellular metabolism and/or regional areas of ischemia without evidence of systemic hypoperfusion. 2 Differentiating between types A and B lactic acidosis can be challenging, 1 and the literature is replete with case reports demonstrating the danger of missing a type B lactic acidosis from a progressive malignancy. [3][4][5] .…”

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confidence: 99%

Elevated Serum Lactate in Patients With Lymphoma: It Is Not Always Infection

Ruan

Gandhi

Abeykoon

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To distinguish between sepsis only vs progressive lymphoma in patients with a history of lymphoma who present to the hospital with lactic acidosis. Patients and Methods: We identified patients with non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma from January 2014 to December 2015. Patients were categorized into 2 groups: sepsis only or progressive lymphoma. Two-sided Wilcoxon rank sum test and c 1 /Fisher exact test were used to compare the continuous and categorical variables, respectively. Kaplan-Meier analysis was used to estimate overall survival (OS). Results: A total of 51 patients were identified; 33 (65%) patients were categorized into the sepsis only group, and 18 (35%), into the progressive lymphoma group. Values for serum lactate dehydrogenase (LDH) drawn during hospitalization were statistically different between the sepsis only and progressive lymphoma groups (median, 262 vs 665 U/L; P¼.005), respectively. The sensitivity and specificity of serum LDH level 2 or more times the upper limit of normal for progressive lymphoma were 56% (95% CI, 33% to 79%) and 85% (95% CI, 73% to 97%), respectively. Serum LDH level was independently predictive of inferior OS (hazard ratio, 27.8; 95% CI, 4.0 to 160.1; P<.001), while serum albumin level (hazard ratio, 0.05; 95% CI, 0.01 to 0.27; P<.001) was independently predictive of improved OS. Conclusion: Serum LDH levels used in conjunction with serial serum lactate values may be reliable markers to differentiate patients with progressive lymphomatous disease from patients with lymphoma with sepsis only. The LDH levels should be obtained in all patients with lymphoma who present to the hospital with lactic acidosis.

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confidence: 99%

Elevated Serum Lactate in Patients With Lymphoma: It Is Not Always Infection

Ruan

Gandhi

Abeykoon

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…Due to the heavy financial burden and required clinical care after the diagnosis of diabetes, current diabetes diagnostic criteria using HbA1c and FPG prefer specificity to sensitivity. Diabetes can cause many serious complications[ 27 ]. To prevent the development of diabetic complications and disability, diabetic patients should be diagnosed early; therefore, the diagnostic criteria for GA in diabetes should moderate the sensitivity to overemphasize specificity.…”

Section: Discussionmentioning

confidence: 99%

“…There is considerable controversy regarding the diabetes diagnostic criteria for HbA1c[ 25 , 26 ], and several studies in east Asia have suggested lowering the HbA1c cutoff for diabetes diagnosis. GA has moderate sensitivity and specificity in monitoring blood glucose[ 27 ]. Our study has added information on the GA cutoff for diabetes diagnosis in northern China.…”

Section: Discussionmentioning

confidence: 99%

Use of glycated albumin for the identification of diabetes in subjects from northeast China

2021

WJD

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BACKGROUND Metabolic memory is important for the diagnosis and treatment of diabetes in the early stage, and in maintaining blood glucose concentrations within the normal range. The clinical diagnosis of diabetes mellitus is currently made using fasting plasma glucose, 2 h-plasma glucose (2h-PG) during a 75 g oral glucose tolerance test, and hemoglobin A1c (HbA1c) level. However, the fasting plasma glucose test requires fasting, which is a barrier to screening, and reproducibility of the 2h-PG level is poor. HbA1c is affected by a shortened red blood cell lifespan. In patients with anemia and hemoglobinopathies, the measured HbA1c levels may be inaccurate. Compared with HbA1c, glycated albumin (GA) is characterized by more rapid and greater changes, and can be used to diagnose new-onset diabetes especially if urgent early treatment is required, for example in gestational diabetes. In this study, we provided cutoff values for GA and evaluated its utility as a screening and diagnostic tool for diabetes in a large high-risk group study. AIM To evaluate the utility of GA in identifying subjects with diabetes in northeast China, and to assess the diagnostic accuracy of the proposed GA cutoff in the diagnosis of diabetes mellitus. METHODS This cross-sectional study included 1935 subjects, with suspected diabetes or in high-risk groups, from 2014 to 2015 in the Second Affiliated Hospital of Harbin Medical University (Harbin, China). The use of GA to identify diabetes was investigated using the area under the receiver operating characteristic curve (AUC). The GA cutoffs were derived from different 2h-PG values with hemoglobin A1c cutoffs used as a calibration curve. RESULTS The GA cutoff for the diagnosis of diabetes mellitus was 15.15% from the receiver operating characteristic (ROC) curve. ROC analysis demonstrated that GA was an efficient marker for detecting diabetes, with an AUC of 90.3%. CONCLUSION Our study supports the use of GA as a biomarker for the diagnosis of diabetes.

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“…In addition to the volume, electrolyte and acid–base imbalance frequently seen in AKI, severe internal environmental disorders can also be caused by hepatotoxins in liver failure, pathogenic microorganisms, and cytokine storms in severe infections, pathogenic antibodies from autoimmune disease, exogenous drugs or poisons entering the body, hyperthermia caused by heat stroke, and so on. [ 20 , 21 ]…”

Section: The Main Characteristics Of Critical Care Blood Purificationmentioning

confidence: 99%