Prognostic Implication of Longitudinal and Peak Lactate Levels after LVAD Implantation

2020 ◽  
Vol 39 (4) ◽  
pp. S342
Author(s):  
M.T. Hassanein ◽  
E.J. Molina ◽  
H. Kitahara ◽  
S.F. Mohammed ◽  
F.H. Sheikh ◽  
...  
Keyword(s):  
Prognostic Implication ◽  
Peak Lactate ◽  
Lactate Levels

scholarly journals Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 284
Author(s):  
Julia Merkle-Storms ◽  
Ilija Djordjevic ◽  
Carolyn Weber ◽  
Soi Avgeridou ◽  
Ihor Krasivskyi ◽  
...  
Keyword(s):  
Roc Analysis ◽  
Operating Characteristic ◽  
Pediatric Patients ◽  
Heart Defects ◽  
Lactate Clearance ◽  
Ecmo Support ◽  
Peak Lactate ◽  
Lactate Levels ◽  
The Impact ◽  
Ecmo Therapy

Background and Objectives: Pediatric extracorporeal membrane oxygenation (ECMO) support is often the ultimate therapy for neonatal and pediatric patients with congenital heart defects after cardiac surgery. The impact of lactate clearance in pediatric patients during ECMO therapy on outcomes has been analyzed. Materials andMethods: We retrospectively analyzed data from 41 pediatric vaECMO patients between January 2006 and December 2016. Blood lactate and lactate clearance have been recorded prior to ECMO implantation and 3, 6, 9 and 12 h after ECMO start. Receiver operating characteristic (ROC) analysis was used to identify cut-off levels for lactate clearance. Results: Lactate levels prior to ECMO therapy (9.8 mmol/L vs. 13.5 mmol/L; p = 0.07) and peak lactate levels during ECMO support (10.4 mmol/L vs. 14.7 mmol/L; p = 0.07) were similar between survivors and nonsurvivors. Areas under the curve (AUC) of lactate clearance at 3, 9 h and 12 h after ECMO start were significantly predictive for mortality (p = 0.017, p = 0.049 and p = 0.006, respectively). Cut-off values of lactate clearance were 3.8%, 51% and 56%. Duration of ECMO support and respiratory ventilation was significantly longer in survivors than in nonsurvivors (p = 0.01 and p < 0.001, respectively). Conclusions: Dynamic recording of lactate clearance after ECMO start is a valuable tool to assess outcomes and effectiveness of ECMO application. Poor lactate clearance during ECMO therapy in pediatric patients is a significant marker for higher mortality.

Hyperlactatemia Predicts Citrate Intolerance With Regional Citrate Anticoagulation During Continuous Renal Replacement Therapy

2017 ◽  
Vol 34 (5) ◽  
pp. 418-425 ◽  
Author(s):  
Jia-Neng Tan ◽  
Sabrina Wong Peixin Haroon ◽  
Amartya Mukhopadhyay ◽  
Titus Lau ◽  
Tanusya M. Murali ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Characteristic Curve ◽  
Kidney Injury ◽  
Serum Lactate ◽  
Organic Substrate ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Peak Lactate ◽  
Lactate Levels

Purpose: We aim to determine whether hyperlactatemia, which suggests multi-organ dysfunction and impaired organic substrate metabolism, may predict intolerance to regional citrate anticoagulation (RCA) during continuous venovenous hemofiltration (CVVH). Methods: We performed a single-center, retrospective observational study in critically ill patients with acute kidney injury or end-stage renal disease and evaluated the association of peak serum lactate levels with citrate intolerance (CI) during the initial 72 hours of RCA-CVVH, defined by serum total-to-ionized calcium >2.5 plus systemic hypocalcemia. Results: Eighty-eight patients were studied (aged 59 ± 14 years, 66% males, Acute Physiology and Chronic Health Evaluation II: 31 ± 8). Citrate was dosed at median 2.1 mmol/L of blood flow, with citrate load of 30 mmol/h, and CVVH effluent of 43 mL/kg/h. Twenty patients developed CI. Comparing patients with CI versus none, peak lactate levels were 8 (5-11) versus 3 (2-6) mmol/L, calcium replacement was 13 (10-17) versus 11 (8-12) mmol/h, and standard base excess was −4 (−12 to 1) versus 2(−4 to 7) mmol/L, respectively ( P < .05). Citrate intolerance developed in 38%, 44%, and 55%, in patients with peak lactate >4, >6, >7 mmol/L, respectively, versus 7% in those with peak lactate ≤4 mmol/L ( P ≤ .001), despite comparable citrate load and effluent rates across all categories. On multivariate analysis, hyperlactatemia and hyperbilirubinemia predicted CI ( P ≤ .01), which was associated with increasing calcium infusion requirement. Higher peak lactate from >4 to >7 mmol/L predicted CI with graded increase in odds ratio and specificity from 59% to 87%, but the corresponding negative predictive value from 93% to 87%. Area under nonparametric receiver operating characteristic curve for peak lactate and CI was 0.78. Conclusion: Hyperlactatemia predicts CI during RCA-CVVH with reasonable discriminatory performance in critically ill patients. Serum lactate surveillance may help preempt issues with citrate toxicity.

Intraabdominal Hypertension in Patients with Septic Shock

2007 ◽  
Vol 73 (9) ◽  
pp. 865-870 ◽  
Author(s):  
Tomas Regueira ◽  
Pablo Hasbun ◽  
Rolando Rebolledo ◽  
Jose Galindo ◽  
Marcia Aguirre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Moderate Increase ◽  
Tertiary Center ◽  
Peak Lactate ◽  
Intraabdominal Hypertension ◽  
Lactate Levels ◽  
High Lactate

Intraabdominal hypertension (IAH) develops frequently in patients with septic shock. Even a moderate increase in intraabdominal pressure (IAP) in this setting could be associated with high lactate levels. The authors conducted a prospective, observational, nonrandomized control trial in the surgical intensive care unit of an academic tertiary center. Twenty-seven patients with septic shock (septic shock group), and 19 patients undergoing abdominal surgery with more than two risk factors for IAH (postoperative control group) were admitted consecutively to the intensive care unit. IAP was measured every 6 hours during the first 48 hours. IAH was diagnosed with two consecutive measurements greater than 20 mm Hg. The main outcome measures were prevalence of IAH in septic shock and control groups; and comparative lactate levels, norepinephrine requirements and organ dysfunctions in patients with and without IAH in both groups. Fifty-one per cent of patients with septic shock and 31 per cent of control patients developed IAH. Patients with septic shock with and without IAH were comparable in peak norepinephrine dose, sequential organ failure assessment score, and mortality. However, peak lactate levels were significantly higher in patients with septic shock and IAH compared with those without IAH (3.5 mmol/L versus 1.9 mmol/L, P < 0.04). There was a significant positive temporal correlation between IAP and lactate levels in patients with septic shock with IAH. Peak levels of both occurred early and decreased progressively over time. Control patients with and without IAH exhibited comparable peak lactate levels. Intraabdominal hypertension is very common in septic shock and appears to be related to high lactate levels, which diminish as IAP decreases. Future studies should address the usefulness of IAP monitoring in patients with septic shock.

scholarly journals Comparison Of Peak Lactate Levels Between A Wingate Test And Dune Climb

2020 ◽  
Vol 52 (7S) ◽  
pp. 52-53
Author(s):  
Jennifer A. Ostrowski ◽  
Thompson C. Paige ◽  
Marlene Wenta
Keyword(s):  
Wingate Test ◽  
Peak Lactate ◽  
Lactate Levels

scholarly journals Analysis of sex-based differences in clinical and molecular responses to ischemia reperfusion after lung transplantation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lourdes Chacon-Alberty ◽  
Shengbin Ye ◽  
Daoud Daoud ◽  
William C. Frankel ◽  
Hassan Virk ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Ischemia Reperfusion ◽  
Molecular Response ◽  
Proinflammatory Response ◽  
Full Cohort ◽  
Molecular Responses ◽  
Peak Lactate ◽  
The Difference ◽  
Grade 3 ◽  
Lactate Levels

Abstract Background Sex and hormones influence immune responses to ischemia reperfusion (IR) and could, therefore, cause sex-related differences in lung transplantation (LTx) outcomes. We compared men’s and women’s clinical and molecular responses to post-LTx IR. Methods In 203 LTx patients, we used the 2016 International Society for Heart and Lung Transplantation guidelines to score primary graft dysfunction (PGD). In a subgroup of 40 patients with blood samples collected before LTx (T0) and 6, 24, 48 (T48), and 72 h (T72) after lung reperfusion, molecular response to IR was examined through serial analysis of circulating cytokine expression. Results After adjustment, women had less grade 3 PGD than men at T48, but not at T72. PGD grade decreased from T0 to T72 more often in women than men. The evolution of PGD (the difference in mean PGD between T72 and T0) was greater in men. However, the evolution of IL-2, IL-7, IL-17a, and basic fibroblast growth factor levels was more often sustained throughout the 72 h in women. In the full cohort, we noted no sex differences in secondary clinical outcomes, but women had significantly lower peak lactate levels than men across the 72 h. Conclusions Men and women differ in the evolution of PGD and cytokine secretion after LTx: Women have a more sustained proinflammatory response than men despite a greater reduction in PGD over time. This interaction between cytokine and PGD responses warrants investigation. Additionally, there may be important sex-related differences that could be used to tailor treatment during or after transplantation.

Value of Lactate Levels during ECMO Support for Refractory Cardiogenic Shock

2016 ◽  
Vol 64 (S 01) ◽  
Author(s):  
I. Slottosch ◽  
O. Liakopoulos ◽  
E. Kuhn ◽  
A. Deppe ◽  
M. Scherner ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Ecmo Support ◽  
Refractory Cardiogenic Shock ◽  
Lactate Levels

Colorectal cancer and vascular invasion: what is the prognostic implication?

Endoscopy ◽  
2006 ◽  
Vol 37 (12) ◽  
Author(s):  
RK Choudhary ◽  
D Debnath ◽  
KA Gunning
Keyword(s):  
Colorectal Cancer ◽  
Vascular Invasion ◽  
Prognostic Implication
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