The association of early combined lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients

Abstract

BackgroundThe development of renal and liver dysfunction may be accompanied by initially subtle derangements in the gluconeogenetic function. Discrepantly low glucose levels combined with high lactate levels might indicate an impaired Cori cycle. Our objective was to examine the relation between early lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients.MethodsOver a 4-year period (2011 to 2014), all adult patients admitted to our adult 48-bed teaching hospital intensive care unit (ICU) for at least 12 h were retrospectively analyzed. Lactate and glucose were regularly measured with point-of-care analyzers in all ICU patients. Lactate and glucose measurements were collected from 6 h before to 24 h after ICU admission. Patients with fewer than four lactate/glucose measurements were excluded. Patients received insulin according to a computer-guided control algorithm that aimed at a glucose level <8.0 mmol/L. Renal dysfunction was defined as the development of acute kidney injury (AKI) within 7 days, and liver function was based on the maximal bilirubin in the 7-day period following ICU admission. Mean lactate and mean glucose were classified into quintiles and univariate and multivariate analyses were related with renal and liver dysfunction and hospital mortality. Since glucose has a known U-shaped relation with outcome, we also accounted for this.ResultsWe analyzed 92,000 blood samples from 9074 patients (63% males) with a median age of 64 years and a hospital mortality of 11%. Both lactate quintiles (≤1.0; 1.0–1.3; 1.3–1.7; 1.7–2.3; >2.3 mmol/L) and glucose quintiles (≤7.0; 7.0–7.6; 7.6–8.2; 8.2–9.0; >9.0 mmol/L) were related with outcome in univariate analysis (p < 0.001). Acute Physiology and Chronic Health Evaluation (APACHE) IV, lactate, and glucose were associated with renal and liver dysfunction in multivariate analysis (p < 0.001), with a U-shaped relationship for glucose. The combination of the highest lactate quintile with the lowest glucose quintile was associated with the highest rates of renal dysfunction, liver dysfunction, and mortality (p < 0.001) with a significant interaction between lactate and glucose (p ≤ 0.001).ConclusionsAbnormal combined lactate and glucose measurements may provide an early indication of organ dysfunction. In critically ill patients a ‘normal’ glucose with an elevated lactate should not be considered desirable, as this combination is related with increased mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1785-z) contains supplementary material, which is available to authorized users.

Change in alkaline phosphatase activity associated with intensive care unit and hospital length of stay in patients with septic acute kidney injury on continuous renal replacement therapy

“…Total AP activity at baseline in our study was similar to the normal range (20–140 U/L) [ 17 ]. In the literature, 9074 critically ill patients showed baseline AP range of 57–93 U/L and maximal of 54–108 U/L [ 18 ], which was comparable to our study. We believe that the reason only liver and bone isoforms increased is that the liver and bone isoforms are predominantly involved in inflammation [ 3 ].…”

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

“…Biologically, lactate has been accepted as a surrogate of physiological stress, microcirculatory dysfunction or tissue hypoxia from multiple aetiologies . In liver failure, lactate clearance may be further impaired by mechanisms yet to be fully understood . Therefore, to use lactate, an easily accessible and widely used parameter in the ICU setting, as an early prognostic marker in patients with ACLF may be worthwhile.…”

Cystathionine-γ-lyase expression is associated with mitochondrial respiration during sepsis-induced acute kidney injury in swine with atherosclerosis

“…Considering previous results from our group in a sepsis study in non-co-morbid young pigs, which displayed two times higher rates of glucose appearance [ 59 ], atherosclerotic pigs in this study seem to fail in their stress-related upregulation of gluconeogenesis. The kidney can account for 25–40% of all glucose released into the circulation and thus plays an important role in glucose homeostasis [ 6 , 60 , 61 ], especially under conditions of catecholamine treatment. Lactate is the predominant precursor for gluconeogenesis in healthy subjects stimulated with epinephrine to simulate physiological stress [ 60 ].…”

“…Septic acute kidney injury (AKI) is characterized by an acute decrease in renal function coinciding with relatively normal histologic morphology [ 1 – 5 ]. The severity of septic AKI is related to vascular leakage [ 1 ], derangements in glucose metabolism [ 6 ], and reduced mitochondrial activity [ 7 , 8 ]. Hydrogen sulfide (H 2 S), an important “gaseous mediator,” has been implicated in all the abovementioned: kidney function, vascular regulation, barrier function, glycemic control, and the mitochondria.…”