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Thiamine status and lactate concentration in sepsis: A prospective observational study.
Heming, N, Salah, A, Meng, P, Sivanandamoorthy, S, Bounab, R, Chevret, S, Annane, D
Medicine. 2020;(7):e18894
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Abstract
Thiamine is an essential co-factor for aerobic metabolism. Both thiamine deficiency and sepsis may be associated with hyperlactatemia and hypotension. We assessed the relationship between thiamine compounds, lactate concentrations and clinical outcomes in septic patients.We undertook a prospective observational single-center study. Erythrocyte levels of total thiamine, free thiamine, thiamine mono, di and triphosphate (TMP, TDP, and TTP respectively), the erythrocyte transketolase activity (ETKA) and the effect of thiamine diphosphate on ETKA were measured in septic patients by high performance liquid chromatography and correlated with arterial lactate. Vital status at the end of intensive care unit stay was recorded.Overall, 28 patients suffering from sepsis were included. Median (interquartile range [IQR]) age was 60 [44-77.3] years, 15 (53.6%) patients were male, median [IQR] simplified acute physiology score II was 40 [27-50]. There was no correlation between total thiamine and lactate levels (P = .33). There was no correlation between free thiamine (P = .81), TMP (P = .71), TDP (P = .31), TTP (P = .86), and lactate levels in our population. There was no correlation between ETKA (P = .58) or the effect of TDP on ETKA (P = .40) and lactate concentration. Total thiamine and TDP concentration were significantly higher in intensive care unit (ICU) survivors than in nonsurvivors (P = .03 and P = .03). The effect of TDP on ETKA was significantly higher in nonsurvivors compared to survivors (P = .04).We found no correlation between thiamine compounds and lactate concentration in sepsis. Thiamine deficiency in sepsis may be associated with ICU-mortality.
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The human central nervous system discharges carbon dioxide and lactic acid into the cerebrospinal fluid.
Akaishi, T, Onishi, E, Abe, M, Toyama, H, Ishizawa, K, Kumagai, M, Kubo, R, Nakashima, I, Aoki, M, Yamauchi, M, et al
Fluids and barriers of the CNS. 2019;(1):8
Abstract
BACKGROUND The central nervous system was previously thought to draw oxygen and nutrition from the arteries and discharge carbon dioxide and other metabolic wastes into the venous system. At present, the functional role of cerebrospinal fluid in brain metabolism is not fully known. METHODS In this prospective observational study, we performed gas analysis on venous blood and cerebrospinal fluid simultaneously acquired from 16 consecutive preoperative patients without any known neurological disorders. RESULTS The carbon dioxide partial pressure (pCO2) (p < 0.0001) and lactic acid level (p < 0.001) in the cerebrospinal fluid were significantly higher than those in the peripheral venous blood, suggesting that a considerable proportion of metabolic carbon dioxide and lactic acid is discharged from the central nervous system into the cerebrospinal fluid. The oxygen partial pressure (pO2) was much higher in the cerebrospinal fluid than in the venous blood, corroborating the conventional theory of cerebrospinal fluid circulatory dynamics. The pCO2 of the cerebrospinal fluid showed a strong negative correlation with age (R = - 0.65, p = 0.0065), but the other studied variables did not show significant correlation with age. CONCLUSION Carbon dioxide and lactic acid are discharged into the circulating cerebrospinal fluid, as well as into the venules. The level of carbon dioxide in the cerebrospinal fluid significantly decreased with age.
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Longer-Period Effects of Bicarbonate/Lactate-Buffered Neutral Peritoneal Dialysis Fluid in Patients Undergoing Peritoneal Dialysis.
Hoshino, T, Kaneko, S, Minato, S, Yanai, K, Mutsuyoshi, Y, Ishii, H, Kitano, T, Shindo, M, Miyazawa, H, Aomatsu, A, et al
Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. 2018;(6):641-648
Abstract
High concentrations of lactate are considered to contribute to impairment of the peritoneal membrane. We investigated the longer-period effects of bicarbonate/lactate-buffered neutral peritoneal dialysis fluid (PDF) in patients undergoing PD for about 2 years. Patients undergoing PD were changed from a lactate-buffered neutral PDF to a bicarbonate/lactate-buffered neutral PDF. We then investigated the patients' clinical outcomes and peritoneal membrane functions as well as the surrogate markers in the drained dialysate. Fourteen patients undergoing PD were enrolled. Peritonitis was observed in one patient. No other adverse events were observed. Peritoneal function did not change as the ultrafiltration volume decreased. Fibrin degradation products and vascular endothelial growth factor in the drained dialysate decreased while the interleukin level increased. These results suggest that bicarbonate/lactate-buffered neutral PDF may have beneficial effects in terms of peritoneal preservation and can be safely used in patients undergoing PD.
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Pronóstico de pacientes con lupus eritematoso generalizado en una unidad de cuidados intensivos.
Ñamendys-Silva, S, Reyes-Ruiz, M, Rivero-Sigarroa, E, Cherit, GD
Gaceta medica de Mexico. 2018;(4):468-472
Abstract
INTRODUCCIÓN: La identificación de factores de riesgo para mortalidad ha permitido mejorar el tratamiento de los pacientes críticos con lupus eritematosos generalizado. OBJETIVO Describir las características clínicas y los pronósticos de pacientes graves con lupus eritematosos generalizado ingresados en una unidad de cuidados intensivos. MÉTODO: Estudio de cohorte, observacional y descriptivo. Se incluyeron 207 pacientes con lupus eritematosos generalizado enero de 2011 y enero de 2016. RESULTADOS Durante el periodo del estudio fueron ingresados 3215 pacientes graves a una unidad de cuidados intensivos, 207 (6.4 %) con lupus eritematosos generalizado después de ser evaluados por un intensivista. La mortalidad fue de 18.4 %. El análisis multivariado identificó la presencia fallas orgánicas (cardiovascular, hepática y neurológica) y niveles séricos de lactato > 2 mmol/L al ingreso o durante las primeras 24 horas de estancia en la unidad de cuidados intensivos como los principales factores asociados con incremento de la mortalidad. CONCLUSIONES Un dato relevante fue que la falla neurológica y la falla hepática estuvieron asociadas con mayor riesgo de muerte a 28 días, sin que identificáramos reportes similares a estos hallazgos. INTRODUCTION Identification of risk factors for mortality has enabled improving the treatment of critically ill patients with systemic lupus erythematosus. OBJECTIVE To describe clinical characteristics and prognoses of critically ill patients with systemic lupus erythematosus admitted to an intensive care unit. METHOD Prospective, observational cohort study. A total of 207 patients with systemic lupus erythematosus admitted between January 2011 and January 2016 were included. RESULTS During the study period, 3,215 critically ill patients were admitted to the intensive care unit, out of which 207 (6.4%) were identified as having systemic lupus erythematosus after being evaluated by an intensivist. The multivariate analysis identified the presence of organ failure (cardiovascular, liver, neurological) and serum lactate levels > 2 mmoL/L at admission or within the first 24 hours of intensive care unit stay as the main factors associated with increased mortality. CONCLUSIONS A relevant observation was that neurological failure and liver failure were associated with higher mortality risk at 28 days, without reports similar to these findings being identified.
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Does increased serum d-lactate mean subclinical hyperpermeability of intestinal barrier in middle-aged nonobese males with OSA?
Heizati, M, Li, N, Shao, L, Yao, X, Wang, Y, Hong, J, Zhou, L, Zhang, D, Chang, G, Abulikemu, S
Medicine. 2017;(49):e9144
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Abstract
Few attention has been directed to the potential effects of intermittent hypoxia experienced in obstructive sleep apnea on the integrity and permeability of intestinal barrier, particularly in adults. Therefore, we evaluated alteration in serum d-lactate concentration in middle-aged males with obstructive sleep apnea to value permeability of intestinal barrier. In this current cross-sectional study, consecutive 159 males were studied. Obstructive sleep apnea was determined by polysomnography and apnea hypopnea index ≥15 event/h was defined as obstructive sleep apnea. D-lactate, lipopolysaccharide binding protein, interleukin-1β, interleukin-6 and tumor necrosis factor-α by ELISA method. Nonobese obstructive sleep apnea (OSA) males showed significantly higher serum d-LA than did nonobese [1374.35 (816-1735) μg/L vs 1166.43 (730-1815) μg/L, P = .018], and obese non-OSA ones [1374.35 (816-1735) μg/L vs 1188.75 (736-1557) μg/L, P = .045], whereas serum LBP levels showed no differences within groups. Serum IL-1β was also slightly higher in nonobese OSA males, but with statistical significance, than in nonobese (19.39 ± 4.67 ng/L vs 17.25 ± 3.66 ng/L, P = .041), and obese non-OSA ones (19.39 ± 4.67 ng/L vs 17.42 ± 3.79 ng/L, P = .047), whereas other biomarkers, IL-6 and TNF-a did not show significant differences among groups. In stepwise multiple linear regression analysis, serum d-LA was independently positively associated with AHI (B = 5.577, P = .022), and ODI3 (B = 4.550, P = .024) and negatively with LSaO2 (B = -12.234, P = .019). Finally, we arrived at a conclusion that serum d-lactate was increased in nonobese middle-aged males with obstrutive sleep apnea, possibly suggesting existence of subclinical disruption of intestinal barrier, and showed significant associations with inflammatory mediators, possibly being involved in systemic inflammation of obstructive sleep apnea.
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Relationship of at Admission Lactate, Unmeasured Anions, and Chloride to the Outcome of Critically Ill Patients.
Masevicius, FD, Rubatto Birri, PN, Risso Vazquez, A, Zechner, FE, Motta, MF, Valenzuela Espinoza, ED, Welsh, S, Guerra Arias, EF, Furche, MA, Berdaguer, FD, et al
Critical care medicine. 2017;(12):e1233-e1239
Abstract
OBJECTIVES To investigate the association between the concentration of the causative anions responsible for the main types of metabolic acidosis and the outcome. DESIGN Prospective observational study. SETTING Teaching ICU. PATIENTS All patients admitted from January 2006 to December 2014. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Four thousand nine hundred one patients were admitted throughout the study period; 1,609 met criteria for metabolic acidosis and 145 had normal acid-base values. The association between at admission lactate, unmeasured anions, and chloride concentration with outcome was assessed by multivariate analysis in the whole cohort and in patients with metabolic acidosis. We also compared the mortality of patients with lactic, unmeasured anions, and hyperchloremic metabolic acidosis with that of patients without acid-base disorders. In the whole population, increased lactate and unmeasured anions were independently associated with increased mortality, even after adjusting for potential confounders (odds ratio [95% CI], 1.14 (1.08-1.20); p < 0.0001 and 1.04 (1.02-1.06); p < 0.0001, respectively). In patients with metabolic acidosis, the results were similar. Patients with lactic and unmeasured anions acidosis, but not those with hyperchloremic acidosis, had an increased mortality compared to patients without alterations (17.7%, 12.7%, 4.9%, and 5.8%, respectively; p < 0.05). CONCLUSIONS In this large cohort of critically ill patients, increased concentrations of lactate and unmeasured anions, but not chloride, were associated with increased mortality. In addition, increased unmeasured anions were the leading cause of metabolic acidosis.
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Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery.
Soliman, R, Fouad, E, Belghith, M, Abdelmageed, T
Annals of cardiac anaesthesia. 2016;(1):45-51
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OBJECTIVE To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. DESIGN An observational study. SETTING Prince Sultan cardiac center, Riyadh, Saudi Arabia. PARTICIPANTS The study included 283 patients classified into two groups: Hemofiltration group (n=138), hemofiltration was done during CPB. Control group (n = 145), patients without hemofiltration. INTERVENTIONS Hemofiltration during cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05), and the PH showed metabolic acidosis in group H (P < 0.05). The mixed venous oxygen saturation decreased in group H than group C (P < 0.05). The number of transfused packed red blood cells was lower in group H than group C (P < 0.05). The hematocrit was higher in group H than group C (P < 0.05). The urine output was lower in group H than group C (P < 0.05). CONCLUSIONS Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.
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Lactate, endothelin, and central venous oxygen saturation as predictors of mortality in patients with Tetralogy of Fallot.
Kapoor, PM, Dhawan, I, Jain, P, Chowdhury, U
Annals of cardiac anaesthesia. 2016;(2):269-76
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BACKGROUND Lactate and central venous oxygen saturation (ScVO2) are well known biomarkers for adequacy of tissue oxygenation. Endothelin, an inflammatory marker has been associated with patient's nutritional status and degree of cyanosis. The aim of this study was to explore the hypothesis that lactate, ScVO2 and endothelin before induction may be predictive of mortality in pediatric cardiac surgery. METHODS We conducted a prospective observational study of 150 pediatric (6 months to 12 years) patients who were posted for intracardiac repair for Tetralogy of Fallot and measured lactate, ScVO2 and endothelin before induction (T1), 20 minutes after protamine administration (T2) and 24 hours after admission to ICU (T3). RESULTS Preinduction lactate and endothelin levels were found to predict mortality in patients of Tetralogy of Fallot with an odds ratio of 6.020 (95% CI 2.111-17.168) and 1.292(95% CI 1.091-1.531) respectively. In the ROC curve analysis for lactate at T1, the AUC was 0.713 (95% CI 0.526-0.899 P = 0.019). At the cutoff value of 1.750 mmol/lt, the sensitivity and specificity for the prediction of mortality was 63.6% and 65.5%, respectively. For endothelin at T1, the AUC was 0.699 (95% CI 0.516-0.883, P = 0.028) and the cutoff value was ≤2.50 (sensitivity, 63.6%; specificity, 58.3 %). ScVO2 (odds ratio 0.85) at all three time intervals, suggested that improving ScVO2 can lead to 15% reduction in mortality. CONCLUSIONS Lactate, ScVO2 and endothelin all showed association with mortality with lactate having the maximum prediction. Lactate was found to be an independent, reliable and cost-effective measure of prediction of mortality in patients with Tetralogy of Fallot.
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Comparing biomarkers of traumatic shock: the utility of anion gap, base excess, and serum lactate in the ED.
Caputo, ND, Kanter, M, Fraser, R, Simon, R
The American journal of emergency medicine. 2015;(9):1134-9
Abstract
BACKGROUND Biomarkers such as serum lactate, anion gap (AG), and base excess (BE) have been shown to be of use in determining shock in patients with seemingly normal vital signs. We seek to determine if these biomarkers can be used interchangeably in patients with trauma in the emergency setting based on their test characteristics and correlation to each other. METHODS A prospective observational cohort study was undertaken at an urban level 1 trauma center. Baseline vital signs, point-of-care BE, AG, and serum lactate were recorded in all patients who presented for trauma. Correlation was determined by linear regression model. Overall test characteristics and relative risk were calculated. RESULTS One hundred patients were enrolled. The median age was 30 years (interquartile range, 24-42 years), and 89% were male. Fifty-three percent of injuries were blunt trauma. Pearson correlation of serum lactate to BE was -0.81 (r(2) = 0.66; 95% confidence interval [CI], 0.53-0.75; P < .001), that of BE to AG was -0.71 (r(2) = 0.5; 95% CI, -0.80 to -0.57; P < .01), and that for serum lactate to AG was 0.71 (r(2) = 0.5; 95% CI, 0.57-0.80; P < .01). CONCLUSIONS This study demonstrates that the biomarkers have similar test characteristics which may make them interchangeable as indicators for the presence of occult shock in patients with trauma. Lactate and BE correlate well with each other; however, AG was not as strongly correlated with either.
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Tissue oxygen saturation as an early indicator of delayed lactate clearance after cardiac surgery: a prospective observational study.
Kopp, R, Dommann, K, Rossaint, R, Schälte, G, Grottke, O, Spillner, J, Rex, S, Marx, G
BMC anesthesiology. 2015;:158
Abstract
BACKGROUND In this observational study near infrared spectroscopy (NIRS) was evaluated as a non-invasive monitor of impaired tissue oxygenation (StO2) after cardiac surgery. StO2, cardiac output, mixed venous oxygen saturation and mean arterial pressure were compared with lactate clearance as established measure for sufficient tissue perfusion and oxygen metabolism. METHODS Forty patients after cardiac surgery (24 aortocoronary bypass grafting, 5 heart valve, 3 ascending aorta and 8 combined procedures) were monitored until postoperative day 1 with NIRS of the thenar muscle (InSpectra™ StO2-monitor, Hutchinson Technology), a pulmonary-artery catheter and intermittent blood gas analyses for the assessment of lactate clearance. RESULTS StO2 was reduced 4 h after surgery (75 ± 6 %), but recovered at day 1 (84 ± 5 %), while lactate concentration remained increased. Using uni- and multivariate regression analysis, minimum StO2 (r = 0.46, p <0.01) and cardiac index (r = 0.40, p <0.05) correlated with lactate clearance at day 1, while minimum mixed venous saturation and mean arterial pressure did not. In a receiver-operating characteristics (ROC) analysis, minimum StO2 (with a threshold of 75 %) predicted a lactate clearance <10 % at day 1 with an area under the ROC-curve of 0.83, a sensitivity of 78 % and a specificity of 88 %. In the subgroup with StO2 <75 %, troponin and creatine kinase MB were significantly increased at day 1. CONCLUSIONS StO2 below 75 % in the first hours after surgery was a better early indicator of persistent impaired lactate clearance at day 1 than cardiac index, mixed venous oxygen saturation or mean arterial pressure.