Liver function and lactate metabolism in the ill surgical patient

Royle, G. T.; Kettlewell, M. G. W.

doi:10.1002/bjs.1800650921

Cited by 11 publications

(2 citation statements)

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“…Lactate kinetics has been investigated [21][22][23][24][25]. An investigation using intravenous infusion of sodium lactate revealed that clearance of lactate from blood in normal postprandial subjects was 17.9 mL/kg/min [21]; it decreased 14.5 mL/kg/min in patients with hepatic dysfunction [22].…”

Section: Discussionmentioning

confidence: 99%

Significance of lactate clearance in septic shock patients with high bilirubin levels.

Takahashi

Nakada

Walley

et al. 2020

Preprint

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Background Although lactate clearance is affected by hepatic function, it is unclear whether the hepatic dysfunction is associated with lactate clearance as a prognostic marker of clinical outcomes in septic shock. We aimed to evaluate association between the lactate clearance and mortality divided by hepatic dysfunction based on total bilirubin level using two cohort of septic shock patients. Methods Lactate clearance, delta base excess and delta anion gap in 24 hours from septic shock onset were analyzed using two cohorts of septic shock patients (derivation cohort, n = 230; validation cohort, n = 396) categorized into two groups by total bilirubin levels (TBIL) < 2 mg/dL and ≥ 2 mg/dL on day 1. The primary analysis was association between lactate clearance and 28-day mortality by total bilirubin category. Results In derivation cohort, lactate clearance was lower in non-survivors compared to survivors in the patients with TBIL ≥ 2 mg/dL (P = 0.0035), while there was a no significant difference in those with TBIL < 2 mg/dL. There were no significant differences in delta base excess and delta anion gap between non-survivors and survivors both in the patients with TBIL ≥ 2 mg/dL and < 2 mg/dL. In the multivariate logistic regression analysis, increased lactate clearance was significantly associated with decreased 28-day mortality in TBIL ≥ 2 mg/d group (10% lactate clearance, adjusted odds ratio 0.88, 95%CI; 0.80–0.97, P = 0.0075), whereas there was no significant association in TBIL < 2 mg/d group. We next tested for lactate clearance in TBIL ≥ 2 mg/dL using the validation cohort; lactate clearance was lower in non-survivors compared to survivors in the TBIL ≥ 2 mg/dL group (P = 0.0006), while no significant difference was observed in TBIL < 2 mg/dL. Increased lactate clearance was significantly associated with decreased 28-day mortality in the TBIL ≥ 2 mg/dL group (10% lactate clearance, adjusted odds ratio 0.89, 95%CI; 0.83–0.96, P = 0.0038); while no significant difference was observed in TBIL < 2 mg/dL in the validation cohort. Conclusions Patients with increased lactate clearance had decreased 28-day mortality when patients had hepatic dysfunction (TBIL ≥ 2 mg/dL) in septic shock.

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Section: Discussionmentioning

confidence: 99%

Significance of lactate clearance in septic shock patients with high bilirubin levels.

Takahashi

Nakada

Walley

et al. 2020

Preprint

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“…Τόσο η αιμάτω-ση όσο και η οξυγόνωση του ήπατος επηρεάζουν την ικανότητα του για την αξιοποίηση των γαλακτικών ιόντων (Royle andKettlewell 1978, Chrusch et al 2000). Έτσι, μείωση της αιμάτωσης του ήπατος κατά 70%, μείωση της μερικής πίεσης του οξυγόνου στο αρ τηριακό αίμα κάτω από 50 mmHg και μείωση του pH κάτω από 7,10 οδηγεί σε μειωμένη κατανάλωση των γαλακτικών ιόντων, η οποία σε συνδυασμό με την αυ ξημένη παραγωγή τους σε τέτοιες καταστάσεις, προ καλεί σοβαρή υπερλακτιαιμία (Arieff 1989, Allen andHolm 2008).…”

Section: ο ρόλος των γαλακτικών ιόντων στο φυσιολογικό μεταβολισμόunclassified

Lactate in intensive care unit

Pavlidou

Savvas

Kazakos

2017

J Hellenic Vet Med Soc

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Lactate is produced in cells under anaerobic conditions. Hyperlactatemia is the increase of the plasma lactateconcentration and lactic acidosis is the elevation in lactate concentration with a decrease in arterial pH. Hyperlactatemia and lactic acidosis are common in shock, but may also occur in many other clinical syndromes. Clinical studies in humans have reported that lactate concentration may contribute to the diagnosis of diseases in an intensive care unit and the estimation of the prognosis. In veterinary literature, clinical trials on lactate concentration in critical patients are rare, however, there are reports indicating its potential significance. Moreover, the severity of disease is linked to high lactate concentrations in the arterial blood, which is considered to be a negative prognostic index, at least in dogs. Lactate is formed in skeletal muscles, brain, heart, skin, intestinal tract, red and white blood cells. In the liver and kidneys it is metabolized up to 50%. In most human cases in intensive care units, hyperlactatemia and lactic acidosis are the result of hypoxia and tissue hypoperfusion. These patients are in a great risk of developing multi-organ failure and they present with high mortality rates. The persistent systemic acidosis affects myocardial contractility, reduces cardiac output and organ perfusion and leads to severe hypoxia. The causes of hyperlactatemia are: high glycolytic flux (alkalosis, release of catecholamine), high production of pyruvate acid and increased metabolic state conditions. Lactic acidosis may be of type A or type B. Lactate concentration can be measured either in whole blood or plasma by two methods: enzymatic chromatography and enzymatic amperometry. The lactate measurement in intensive care units is important, as it can be used to assess organ hypoperfusion and hypoxia, effectiveness of treatment and prognosis of various pathological conditions, such as septic peritonitis, gastric volvulus, pyometra and babesiosis. The treatment of lactic acidosis depends on the severity and management of the underlying disease. The goal of treatment is adequate tissue perfusion and oxygenation, which is achieved by ventilation and fluid therapy. The microbial infections are treated with antibiotics. The use of bicarbonate is still controversial.

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