Lactate and number of organ failures predict intensive care unit mortality in patients with acute‐on‐chronic liver failure

Cardoso, Filipe S.; Abraldes, Juan G.; Sy, Eric; Ronco, Juan J.; Bagulho, Luís; McPhail, Mark; Karvellas, Constantine J.

doi:10.1111/liv.14083

Cited by 45 publications

(39 citation statements)

References 26 publications

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“…Most patients had infection, sepsis, and even multi-organ failures at ICU admission. A recent multicenter study revealed that ICU and hospital mortality rates in critically ill patients with ACLF were 39.2% and 54.6%, respectively [15]. The hospital and 1-year mortality of patients with ACLF in our study were 49.1% and 63.9%.…”

Section: Discussionmentioning

confidence: 42%

“…Several scoring systems incorporating lactate levels have been established to evaluate the prognosis of patients with cirrhosis and ACLF [15–18]. The liver injury and failure evaluation (LiFe) score, which is calculated using arterial lactate, serves as a useful tool for predicting the mortality of critically ill patients with cirrhosis and ACLF [17, 18].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study

Gao

Huang

Cai

et al. 2019

Aging

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Lactate clearance (Δ24Lac) was reported to be inversely associated with mortality in critically ill patients. The aim of our study was to assess the value of Δ24Lac for the prognosis of critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF). We analysed 954 cirrhotic patients with hyperlactatemia admitted to intensive care units (ICUs) in the United States and eastern China. The patients were followed up for at least 1 year. In the unadjusted model, we observed a 15% decrease in hospital mortality with each 10% increase in Δ24Lac. In the fully adjusted model, the relationship between the risk of death and Δ24Lac remained statistically significant (hospital mortality: odds ratio [OR] 0.84, 95% confidence interval [CI]: 0.78- 0.90, p < 0.001; 90-day mortality: hazard ratio [HR] 0.94, 95%CI 0.92- 0.97, p < 0.001; for Δ24Lac per 10% increase). Similar results were found in patients with ACLF. We developed a Δ24Lac-adjusted score (LiFe-Δ24Lac), which performed significantly better in the area under the receiver operating characteristic curves (AUROCs) than the original LiFe score for predicting mortality. Lactate clearance is an independent predictor of death, and the LiFe-Δ24Lac score is a practical tool for stratifying the risk of death.

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Section: Discussionmentioning

confidence: 42%

Section: Introductionmentioning

confidence: 99%

Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study

Gao

Huang

Cai

et al. 2019

Aging

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“…Monitoring of lactate levels is important in ICU patients with sepsis [ 23 , 24 ]. The liver accounts for 70% of lactate clearance in the human body [ 25 ], and several studies have focused on the importance of lactate and lactate clearance in critically ill patients with cirrhosis and in ACLF patients [ 7 , 8 , 26 , 27 ]. Some studies proved that using lactate level could improve the accuracy of the traditional model, and constructed improved models like CLIF-C ACLFs Lact [ 8 ] and MELD-LA [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have found that lactate levels have good predictive value in critically ill patients with cirrhosis [ 7 – 9 ], and several traditional models were improved by adding lactate, such as CLIF-C ACLFs Lact [ 8 ]. However, most of the models are too complex to use at bedside.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Acute-On-Chronic Liver Failure (ACLF) Score in Critically Ill Patients with Cirrhosis and ACLF

et al. 2020

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Background In the intensive care unit (ICU), critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF) continue to have high mortality rates. The AARC ACLF score is a simple, newly-developed score based on Asian ACLF patients, which performs well in prognosis. The present study attempted to verify the prognostic ability of AARC ACLF in non-Asian critically ill patients with cirrhosis and ACLF. Material/Methods We enrolled 786 patients. Relevant clinical data were collected within 24 h after admission to compare the differences between survivors and non-survivors, and all the patients were followed up for at least 180 days. Results The 28-day, 90-day, and 180-day mortality rates were 28.9% (227/786), 36.4% (286/786), and 40.3% (317/786), respectively. Multivariate Cox regression analysis showed that AARC ACLF score (HR: 1.375, 95% CI: 1.247–1.516, P<0.001) was an independent predictive factor of 28-day mortality, and the AUROC of the predictive ability in 28-day mortality of the AARC ACLF score was 0.754. In addition, the AARC ACLF score was regraded into 3 classes (low risk: AARC ACLF <9, intermediate risk: 9≤ AARC ACLF <12, and high risk: AARC ACLF ≥12). The AARC ACLF score can be used for dynamic assessment by retest at days 4–7. Conclusions The AARC ACLF score has a good predictive value for 28-day, 90-day, and 180-day mortality in non-Asian critically ill patients with cirrhosis and ACLF, which is not inferior to CLIF-C ACLFs Lact and other models. It is easy to use at bedside, and it is dynamic and reliable.

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“…Patients with liver failure due to abnormal liver function rather than causes such as acetaminophen overdose or viral attack usually experience metabolic disorders, acid-base imbalances, decreased liver function over time, and decreased metabolism, which result in recycling and accumulation of lactate. The level of lactate in serum has become an important objective indicator to evaluate the prognosis of patients with cirrhosis and liver failure [40][41][42]. In addition, it has been shown that the rate of lactate clearance is a good and independent predictor of death in critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF) [43].…”

Section: Discussionmentioning

confidence: 99%

Serum Lactate: Creatinine Ratio as a Prognostic Marker for Liver Failure Patients Treated by artificial liver support systems

Sun¹,

Chen²,

Zhou³

et al. 2020

Preprint

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Background: To screen potential serum prognostic markers for patients with liver failure treated by artificial liver support systems (ALSSs).Methods: Serum samples were obtained from 57 liver-failure patients before and after ALSSs therapy and analyzed by proton nuclear magnetic resonance. The diagnostic values were evaluated by calculation of the area under a receiver-operating characteristic curve (AUROC). Two retrospective analyses were further employed.Results: Metabonomics analysis showed that ratios of creatine:creatinine, taurine:creatinine, and lactate:creatinine were significantly altered and restored to normal levels after ALSSs treatment. The ratio of lactate:creatinine showed the highest AUROC value (0.650), which was higher than that of the prothrombin time activity (PTA, 0.562). A total of 105 cases of retrospective analysis showed that serum lactate:creatinine ratios among the liver-failure patients were 0.038 ± 0.002 (survival group, n=48), 0.048 ± 0.005 (three-month death group, n=24), and 0.052 ± 0.005 (one-month death group, n=33), which was significantly negatively correlated with survival (r= - 0.26). Another retrospective cohort analysis (n=81) of the early to middle stage liver-failure patients treated by ALSSs showed that the AUROC of the lactate:creatinine ratio for diagnosis of those who survived for one subsequent month was 0.827, which was higher than that of PTA (0.628) and lactate (0.765).Conclusion: The serum lactate:creatinine ratio may be a more sensitive measure than either the PTA or the lactate to evaluate the prognosis of ALSSs treatment in early to middle stage of liver-failure patients. This finding is worthy of further study in clinical applications.

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Lactate and number of organ failures predict intensive care unit mortality in patients with acute‐on‐chronic liver failure

Cited by 45 publications

References 26 publications

Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study

Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study

Prognostic Value of Acute-On-Chronic Liver Failure (ACLF) Score in Critically Ill Patients with Cirrhosis and ACLF

Serum Lactate: Creatinine Ratio as a Prognostic Marker for Liver Failure Patients Treated by artificial liver support systems

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