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

Gao, Feng; Huang, Xielin; Cai, Mengxing; Lin, Miao-Tong; Wang, Bin-feng; Wu, Wei; Huang, Zhiming

doi:10.18632/aging.102062

Cited by 18 publications

(20 citation statements)

References 35 publications

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“…Non Two Chinese groups have externally validated the LiFe score. 3,17 Yao et al 3 used the US single-centre database Medical Information Mart for Intensive Care-III (MIMIC-III) 22 for analysis. The cohort had a similar mean age (57.2 (SD 11.8)) and an ICU mortality of 31.5%.…”

Section: One-year Survivorsmentioning

confidence: 99%

“…Of note, this group reported that replacing lactate with lactate clearance (reduction within the first 24 h) significantly improved discrimination (in-hospital mortality AUC 0.75; 90-day: 0.70 and one-year: 0.69, all P < 0.01 for comparisons). 17 A small single centre study from Scotland (n ¼ 83) proposed a similar score to LiFe which also incorporated albumin and found a good discrimination to predict one-year survival. 24 This study also showed that patients with variceal bleeding had a lower mortality, as reported in previous studies.…”

Section: One-year Survivorsmentioning

confidence: 99%

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Predicting outcome in liver patients admitted to intensive care: A dual-centre non-specialist hospital external validation of the Liver injury and Failure evaluation score

Sausmarez

Crowest

Fry

et al. 2020

Journal of the Intensive Care Society

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Background Acute hepatic dysfunction in the critically ill population with pre-existing liver cirrhosis is associated with a high mortality. Several prediction models have been developed to risk stratify patients with liver disease. Methods This UK dual-centre non-specialist hospital retrospective study (2015–2019) externally validated the Liver injury and Failure evaluation score (incorporating lactate, bilirubin and International Normalised Ratio), alongside two other general intensive care unit prediction models (Intensive Care National Audit and Research Centre and Acute Physiology and Chronic Health Evaluation II). Inclusion criteria matched a recent UK-wide study including at least one of biopsy proven cirrhosis, imaging suggestive of cirrhosis, hepatic encephalopathy or portal hypertension. Results One hundred and ninety-nine admissions met inclusion criteria over the study period (n = 169), mean age 57( ±13). In-hospital mortality was 40% in this cohort compared to 18% of all intensive care unit individuals during the same period. Variceal bleeding was associated with a lower short-term (18% versus 47%, P < 0.001, odds ratio 0.3 (95% confidence interval 0.1–0.5)) and longer-term mortality (log rank P = 0.015). In-patient mortality was higher in cases requiring renal replacement therapy (82% versus 29%, odds ratio 11.1 (95% confidence interval 4.6–26.9), P < 0.001) or ventilation (47% versus 32%, odds ratio 1.9 (1.1–3.4), P = 0.03). For in-patient mortality, area under the receiver operating characteristic curves were Liver injury and Failure evaluation 0.69 (95% confidence interval 0.62–0.77), Intensive Care National Audit and Research Centre 0.80 (0.74–0.86) and Acute Physiology and Chronic Health Evaluation II 0.73 (0.65–0.81). Forty-one per cent of cases were alive at one-year follow-up. Area under the receiver operating characteristic curves for one-year survival were Liver injury and Failure evaluation 0.69 (0.61–0.77), Intensive Care National Audit and Research Centre 0.75 (0.67–0.82) and Acute Physiology and Chronic Health Evaluation II 0.69 (0.61–0.77). Conclusion This first Liver injury and Failure evaluation score validation in a UK non-specialist hospital setting suggests this parsimonious, easy to calculate model may have utility in prediction of short-term and one-year mortality. As with previous studies variceal haemorrhage was associated with lower mortality.

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Section: One-year Survivorsmentioning

confidence: 99%

Section: One-year Survivorsmentioning

confidence: 99%

Predicting outcome in liver patients admitted to intensive care: A dual-centre non-specialist hospital external validation of the Liver injury and Failure evaluation score

Sausmarez

Crowest

Fry

et al. 2020

Journal of the Intensive Care Society

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“…The level of lactate in serum has become an important objective indicator to evaluate the prognosis of patients with cirrhosis and LF [41][42][43]. 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 [44]. Creatinine is a metabolite that is a byproduct of muscle metabolism.…”

Section: Discussionmentioning

confidence: 99%

Serum Lactate:Creatinine Ratio as a Potential Therapeutic Markers of Liver Failure Patients Treated by Artificial Liver Support Systems

Sun

Chen

Zhou

et al. 2021

Preprint

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Artificial liver support systems (ALSSs) have been recommended as important approaches for treating liver fuilure (LF) patients. However, very few studies have focused on the screening of potential serum therapeutic markers of LF patients treated by ALSSs. Here, serum samples were obtained from 57 LF patients before and after ALSSs treatment and analyzed by metabonomics. The results 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 area under a receiver-operating characteristic curve (AUROC) value (0.650), which was higher than that of the prothrombin time activity (PTA, 0.562). A retrospective analysis showed that serum lactate:creatinine ratios among the LF patient groups 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 LF patients showed that the lactate-creatinine ratio in the death group remained unchanged, but fell markedly in the survival group (0.052 ± 0.005 vs. 0.025 ± 0.002) after ALSSs treatment. In comparison, the serum PTA levels were no statistical differences of in both the death group and survival group after ALSSs treatment. The AUROC of serum lactate-creatinine ratio and PTA after ALSSs treatment for diagnosis of survival group from death group was 0.682 and 0.591 respectively. These results indicate that the serum lactate-creatinine ratio may be more reliable than measures of PTA to evaluate the therapeutic effect of ALSSs treatment in LF patients.

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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%

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

Cited by 18 publications

References 35 publications

Predicting outcome in liver patients admitted to intensive care: A dual-centre non-specialist hospital external validation of the Liver injury and Failure evaluation score

Predicting outcome in liver patients admitted to intensive care: A dual-centre non-specialist hospital external validation of the Liver injury and Failure evaluation score

Serum Lactate:Creatinine Ratio as a Potential Therapeutic Markers of Liver Failure Patients Treated by Artificial Liver Support Systems

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

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