Early lactate clearance as a reliable predictor of initial poor graft function after orthotopic liver transplantation

BACKGROUND:Initial poor graft function (IPGF) following orthotopic liver transplantation is a major determinant of postoperative survival and morbidity.Lactate clearance is a good marker of liver function.In this study,we investigated the clinical utility of early lactate clearance as an early and accurate predictor for IPGF following liver transplantation.METHODS:This was a prospective observational study of 222 patients referred to the surgical intensive care unit (SICU) after orthotopic liver transplantation.The IPGF group consisted of patients with alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) >1500 IU/L within 72 hours after orthotopic liver transplantation.Early lactate clearance was defined as lactate at SICU presentation (hour 0) minus lactate at hour 6,divided by lactate at SICU presentation.The model for end-stage liver disease (MELD) score,Child-Pugh score and laboratory data including AST,ALT,total bilirubin (TB) and prothrombin time (PT) were recorded at SICU presentation and compared between the non-IPGF and IPGF groups Receiver operating characteristic (ROC) curves were plotted to measure the performance of early lactate clearance,MELD score,Child-Pugh score,TB and PT.RESULTS:IPGF occurred in 45 of the 222 patients (20.3%).The early lactate clearance in the non-IPGF group was markedly higher than that in the IPGF group (43.2±13.8% vs 13.4±13.7% P<0.001).The optimum cut-off value for early lactate clearance predicting IPGF was 24.8% (sensitivity 95.5%,specificity 88.9%).The area under the curve of the ROC was 0.961,which was significantly superior to MELD score,Child-Pugh score TB and PT.Patients with early lactate clearance ≤24.8% had a higher IPGF rate (OR=169) and a higher risk of in-hospital mortality (OR=3.625).CONCLUSIONS:Early lactate clearance can serve as a prompt and accurate bedside predictor of IPGF.Patients with early lactate clearance less than 24.8% are associated with a higher incidence of IPGF.

The 6-hour lactate clearance rate in predicting 30-day mortality in cardiogenic shock

Background Early evaluation of prognosis in cardiogenic shock(CS)is crucial for tailored treatment selection.Both lactate clearance and lactate levels are considered useful prognostic biomarkers in patients with CS.However,there is yet no literature comparing the 6-hour lactate clearance rate(Δ6Lac)with lactate levels measured at admission(L1)and after 6 h(L2)to predict 30-day mortality in CS.Methods In this observational cohort study,95 patients with CS were treated at Department of Intensive Care Unit,Yiwu Central Hospital between January 2020 and December 2022.Of these,88 patients met the eligibility criteria.The lactate levels were measured after admission(L1)as the baseline lactate value,and were measured after 6 h(L2)following admission.The primary endpoint of the study was survival rate at 30 days.A receiver operating characteristic curve was used for data analysis.Univariate and multivariate Cox regression analyses were performed based onΔ6Lac.Kaplan–Meier(KM)survival curves were generated to compare the 30-day survival rates among L1,L2,andΔ6Lac.Results TheΔ6Lac model showed the highest area under the curve value(0.839),followed by the L2(0.805)and L1(0.668)models.TheΔ6Lac model showed a sensitivity of 84.2%and specificity of 75.4%.The L1 and L2 models had sensitivities of 57.9%each and specificities of 89.9%and 98.6%,respectively.The cut-off values forΔ6Lac,L1,and L2 were 18.2%,6.7 mmol/L,and 6.1 mmol/L,respectively.Univariate Cox regression analysis revealed a significant association betweenΔ6Lac and 30-day mortality.After adjusting for five models in multivariate Cox regression,Δ6Lac remained a significant risk factor for 30-day mortality in patients with CS.In our fifth multivariate Cox regression model,Δ6Lac remained a risk factor associated with 30-day mortality(hazard ratio[HR]=5.14,95%confidence interval[CI]:1.48 to 17.89,P=0.010)as well as L2(HR=8.42,95%CI:1.26 to 56.22,P=0.028).The KM survival curve analysis revealed that L1>6.7 mmol/L(HR=8.08,95%CI:3.23 to 20.20,P<0.001),L2>6.1 mmol/L(HR=25.97,95%CI:9.76 to 69.15,P<0.001),andΔ6Lac≤18.2%(HR=8.92,95%CI:2.95 to 26.95,P<0.001)were associated with a higher risk of 30-day mortality.ConclusionsΔ6Lac is a better predictor for 30-day mortality in CS than lactate levels at admission.It has a predictive value equivalent to that of lactate level at 6 h after admission,making it an important surrogate indicator for evaluating the suitability as well as poor prognosis after CS treatment.We found that a cut-off value of 18.2%forΔ6Lac provided the most accurate assessment of early prognosis in CS.

Effect of Shenfu Injection(参附注射液)on Lactate and Lactate Clearance in Patients with Post-cardiac Arrest Syndrome:A Post Hoc Analysis of a Multicenter Randomized Controlled Trial

Objective: To assess the effects of Shenfu Injection(参附注射液, SFI) on blood lactate, and secondarily its effect on the lactate clearance(LC) in patients with post cardiac arrest syndrome(PCAS). Methods: The present study is a post hoc study of a randomized, assessor-blinded, controlled trial. Patients experienced in-hospital cardiac arrest between 2012 and 2015 were included in the predefined post hoc analyses. Of 1,022 patients enrolled, a total of 978 patients were allocated to the control group(486 cases) and SFI(492 cases) group, receiving standardized post-resuscitation care bundle(PRCB) treatment or PRCB combined with SFI(100 mL/d), respectively. Patients’ serum lactate was measured simutaneously with artery blood gas, lactate clearance(LC) was calculated on days 1, 3, and 7 after admission and compared between groups. Lactate and LC were also compared between the survivors and non-survivors according to the 28-d mortality, as well as the survivors and non-survivors subgroups both in the SFI and control groups. Results: In both groups, compared with pre-treatment levels, mean arterial pressure(MAP) and PaOwere significantly improved on 1, 3, 7 d after treatment(P<0.05), while heart rate(HR) and blood glucose levels were significantly decreased on 1, 3 and 7 d after treatment(P<0.05). compared with control group, SFI treatment improved the values of MAP and PaO(P<0.05), and significantly decreased the levels of HR and the blood glucose level on 3 and 7 d after treatment(P<0.05). Compared with the control group, lactate levels decreased faster in the SFI group versus the control group on 3 and 7 d(P<0.05). From initiation of treatment and the following 3 and 7 d, SFI treatment greatly increased the LC compared with that in the control group(P<0.05). Compared with survivors, non-survivors had higher admission lactate levels(7.3±1.1 mmol/L vs. 5.5±2.3 mmol/L;P <0.01), higher lactate levels on days 1, 3 and 7(P <0.05), and LC were decreased significantly on 3 and 7 d after treatment(P<0.05). Similar results were also found both in the SFI and control groups between survivors and non-survivors subgroups. Conclusion: SFI in combination with PRCB treatment is effective at lowering lactate level and resulted in increasing LC in a targeted population of PCAS patients.

The Effect of Clinically Used Crystalloid Solution on the Clearance Rate of Lactic Acid in Septic Shock Patients

Objective: To explore the effect of clinically available crystalloids on lactate clearance in patients with septic shock Methods: Sixty-eight patients with septic shock who were treated in our hospital from January 2017 to January 2019 were enrolled in the study. The selected patients were randomly divided into three groups: sodium lactate Ringer's solution group (LR group), saline group (NS group) and compound sodium chloride injection group (RS group), each group received the corresponding crystal liquid for fluid resuscitation, compare three groups Heart rate (HR), mean arterial pressure (MAP), cardiac output, procalcitonin (PCT), and C-reactive protein (CRP) before and after treatment, compared with the treatment of 24 hours of lactate clearance and APACHE II scores, and the overall hospitalization time and mortality rate of the three groups of patients were statistically compared;Results: (1) The difference of HR, MAP and cardiac output between the three groups before treatment was not statistically significant (P>0.05), treatment for 24h The HR of the post-Lactate Ringer's solution group was lower than that of the control group, and the MAP and cardiac output were higher than the control group (P<0.05). (2) The difference of PCT, CRP and BNP levels between the three groups before and after treatment was not statistically significant. (P>0.05);(3) Compared with the results, there was no statistically significant difference in the clearance rate of lactate clearance between the three groups (P>0.05). Three groups before and after treatment APACHE II score was not statistically significant difference comparison (P> 0.05). (4) Three groups The overall hospitalization time and mortality rate of the patients were not statistically significant (P>0.05). Conclusion: Lactate Ringer's solution can better maintain the circulation capacity and blood pressure, which can alleviate the clinical symptoms of patients with septic shock, but no obvious effect on lactic acid clearance. The effect of resuscitation with clinically available crystalloid sodium lactate Ringer's solution, saline and compound sodium chloride injection was not statistically significant in patients with septic shock.