Research Paper Volume 11, Issue 13 pp 4446—4462
Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study
- 1 Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- 2 Department of Gastroenterology Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- 3 Department of Cardiovascular Medicine, The Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- 4 Department of Emergency Medicine, Intensive Care, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Received: March 11, 2019 Accepted: June 25, 2019 Published: July 1, 2019
https://doi.org/10.18632/aging.102062How to Cite
Copyright: Gao et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
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.
Abbreviations
Δ24Lac: lactate clearance; ACLF: acute-on-chronic liver failure; AUROC: area under the receiver- operating characteristic curve; CI: confidence interval; CLIF-SOFA: chronic liver failure (CLIF)-SOFA; HR: hazard ratio; ICU: intensive care unit; INR: international normalized ratio; IQR: interquartile range; LiFe: liver injury and failure evaluation; MELD: model for end-stage liver disease; OR: odds ratio; PTAR: pro-thrombin time–international normalized ratio to albumin ratio; SOFA: sequential organ failure assessment; WBC: white blood cell count.