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Straarup D, Gotschalck KA, Christensen PA, Rasmussen RW, Krarup H, Lundbye-Christensen S, Handberg A, Thorlacius-Ussing O. Exploring D-Lactate as a Biomarker for Acute Intestinal Necrosis in 2958 Patients: A Prospective Cross-Sectional Study. J Emerg Med 2024:S0736-4679(24)00005-2. [PMID: 38556374 DOI: 10.1016/j.jemermed.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/16/2023] [Accepted: 01/06/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Timely diagnosis of acute intestinal necrosis (AIN) is lifesaving, but challenging due to unclear clinical presentation. D-lactate has been proposed as an AIN biomarker. OBJECTIVES We aimed to test the diagnostic performance in a clinical setting. METHODS We performed a cross-sectional prospective study, including all adult patients with acute referral to a single tertiary gastrointestinal surgical department during 2015-2016 and supplemented by enrollment of high-risk in-hospital patients suspected of having AIN during 2016-2019. AIN was verified intraoperatively, and D-lactate was analyzed using an automatic spectrophotometric set-up. A D-lactate cut-off for AIN was estimated using the receiver operating characteristic curve. The performance according to patient subgroups was estimated using the area under the receiver operating characteristic curve (AUC). Given the exploratory nature of this study, a formal power calculation was not feasible. RESULTS Forty-four AIN patients and 2914 controls were enrolled. The D-lactate cut-off was found to be 0.0925 mM. Due to lipemic interference, D-lactate could not be quantified in half of the patients, leaving 23 AIN patients and 1456 controls for analysis. The AUC for the diagnosis of AIN by D-lactate was 0.588 (95% confidence interval 0.475-0.712), with a sensitivity of 0.261 and specificity of 0.892. Analysis of high-risk patients showed similar results (AUC 0.579; 95% confidence interval 0.422-0.736). CONCLUSION D-lactate showed low sensitivity for AIN in both average-risk and high-risk patients. Moreover, lipemic interference precluded valid spectrophotometric assessment of D-lactate in half of the patients, further disqualifying the clinical utility of D-lactate as a diagnostic marker for AIN.
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Affiliation(s)
- David Straarup
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Kåre A Gotschalck
- Department of Gastrointestinal Surgery, Horsens Regional Hospital, Horsens, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter A Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry
| | | | - Henrik Krarup
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry; Department of Molecular Diagnostics
| | | | - Aase Handberg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry
| | - Ole Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Turban A, Gaubert S, Luque-Paz D, René C, Collet N, Pawlowski M, Bendavid C, Lefèvre CR. Validation of a short turnaround time automated method for the 24/7 determination of plasma d-lactate on Roche Cobas c502. Pract Lab Med 2023; 36:e00317. [PMID: 37425622 PMCID: PMC10329164 DOI: 10.1016/j.plabm.2023.e00317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 12/29/2022] [Accepted: 06/19/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Adrien Turban
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Sophie Gaubert
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - David Luque-Paz
- Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Céline René
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Nicolas Collet
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Maxime Pawlowski
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Claude Bendavid
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
| | - Charles R Lefèvre
- Laboratoire de Biochimie-Toxicologie, Centre Hospitalier Universitaire de Rennes, F-35033, Rennes, France
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Lefèvre CR, Turban A, Luque Paz D, Penven M, René C, Langlois B, Pawlowski M, Collet N, Piau C, Cattoir V, Bendavid C. Early detection of plasma d-lactate: Toward a new highly-specific biomarker of bacteraemia? Heliyon 2023; 9:e16466. [PMID: 37265627 PMCID: PMC10230201 DOI: 10.1016/j.heliyon.2023.e16466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/18/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023] Open
Abstract
Background Bloodstream infections are a leading cause of mortality. Their detection relies on blood cultures (BCs) but time to positivity is often between tens of hours and days. d-lactate is a metabolite widely produced by bacteria but very few in human. We aimed to evaluate d-lactate, d-lactate/l-lactate ratio and d-lactate/total lactate ratio in plasma as potential early biomarkers of bacteraemia on a strictly biological standpoint. Methods A total of 228 plasma specimens were collected from patients who had confirmed bacteraemia (n = 131) and healthy outpatients (n = 97). Specific l-lactate and d-lactate analyses were performed using enzymatic assays and analytical performances of d-lactate, d-lactate/total lactate and d-lactate/l-lactate ratios for the diagnosis of bacteraemia were assessed. Results A preliminary in vitro study confirmed that all strains of Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus were able to produce d-lactate at significant levels. In patients, plasma d-lactate level was the most specific biomarker predicting a bacteraemia profile with a specificity and predictive positive value of 100% using a cut-off of 131 μmol.L-1. However, sensitivity and negative predictive value were rather low, estimated at 31% and 52%, respectively. d-lactate displayed an Area Under Receiver Operating Characteristic (AUROC) curve of 0.696 with a P value < 0.0001. There was no difference of d-lactate levels between BCs bottles positive for Gram-positive or Gram-negative bacteria (p = 0.55). Conclusion d-lactate shows promise as a specific early biomarker of bacterial metabolism. The development of rapid automated assays could raise clinical applications for infectious diseases diagnosis including early bacteraemia prediction.
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Affiliation(s)
- Charles R. Lefèvre
- Biochemistry Laboratory, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Adrien Turban
- Bacteriology Laboratory, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - David Luque Paz
- Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Malo Penven
- Bacteriology Laboratory, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Céline René
- Biochemistry Laboratory, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | | | - Maxime Pawlowski
- Biochemistry Laboratory, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Nicolas Collet
- Biochemistry Laboratory, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Caroline Piau
- Bacteriology Laboratory, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Vincent Cattoir
- Bacteriology Laboratory, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
| | - Claude Bendavid
- Biochemistry Laboratory, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
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Linde H, Bartusevicius V, Norberg Å, Klevebro F, Grip J. Frequency of blood lactate elevation following esophagectomy and its association to postoperative complications. Acta Anaesthesiol Scand 2023; 67:277-283. [PMID: 36537042 DOI: 10.1111/aas.14181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Esophagectomy is a major surgical intervention and a cornerstone in the treatment of esophageal cancer. There is clinical experience that blood lactate concentration often is elevated in the period following esophagectomy, but the incidence and clinical consequences are sparsely studied. METHODS We extracted data from all patients undergoing esophagectomy at Karolinska University Hospital 2016-2018, n = 153. Most were performed with minimally invasive technique, n = 130. Blood lactate values directly after surgery, highest value during the first night, and morning level on postoperative day one were recorded. Primary outcome was hospital length of stay and secondary outcome was a composite of postoperative infection, additional surgery, or intensive care during the hospital stay. Development of anastomotic leak was analyzed separately. RESULTS Postoperative hyperlactatemia was common as 93% of patients had peak lactate concentration >1.6 mmol/L and 27% >3.5 mmol/L in the first night following operation. Median hospital length of stay was 14 days. Blood lactate showed a weak correlation to hospital stay and intensive care the morning following surgery, but not at arrival to postoperative ward. There were no statistical differences between those with and without anastomotic leak at any of the time points. Elevated lactate in the first 12-16 h postoperatively was related to surgical factors (open technique, surgery time, and perioperative bleeding) but not to patient related factors (ASA-class, Charlson comorbidity index, sex, age) or cumulative fluid balance. CONCLUSION In conclusion, elevated blood lactate in the immediate time following esophagectomy showed a weak association to intensive care and length of stay but not anastomotic leak.
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Affiliation(s)
- Henrik Linde
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Vilhelmas Bartusevicius
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Åke Norberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Sweden
| | - Fredrik Klevebro
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jonathan Grip
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Sweden
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Pohanka M. D-Lactic Acid as a Metabolite: Toxicology, Diagnosis, and Detection. Biomed Res Int 2020; 2020:3419034. [PMID: 32685468 DOI: 10.1155/2020/3419034] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/20/2020] [Accepted: 06/06/2020] [Indexed: 01/18/2023]
Abstract
Two enantiomers of lactic acid exist. While L-lactic acid is a common compound of human metabolism, D-lactic acid is produced by some strains of microorganism or by some less relevant metabolic pathways. While L-lactic acid is an endogenous compound, D-lactic acid is a harmful enantiomer. Exposure to D-lactic acid can happen by various ways including contaminated food and beverages and by microbiota during some pathological states like short bowel syndrome. The exposure to D-lactic acid cannot be diagnosed because the common analytical methods are not suitable for distinguishing between the two enantiomers. In this review, pathways for D-lactic acid, pathological processes, and diagnostical and analytical methods are introduced followed by figures and tables. The current literature is summarized and discussed.
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Peoc’h K, Nuzzo A, Guedj K, Paugam C, Corcos O. Diagnosis biomarkers in acute intestinal ischemic injury: so close, yet so far. ACTA ACUST UNITED AC 2017; 56:373-385. [DOI: 10.1515/cclm-2017-0291] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/21/2017] [Indexed: 12/20/2022]
Abstract
Abstract
Acute intestinal ischemic injury (i3) is a life-threatening condition with disastrous prognosis, which is currently difficult to diagnose at the early stages of the disease; a rapid diagnosis is mandatory to avoid irreversible ischemia, extensive bowel resection, sepsis and death. The overlapping protein expression of liver and gut related to the complex physiopathology of the disease, the heterogeneity of the disease and its relative rarity could explain the lack of a useful early biochemical marker of i3. Apart from non-specific biological markers of thrombosis, hypoxia inflammation, and infection, several more specific biomarkers in relation with the gut barrier dysfunction, the villi injury and the enterocyte mass have been used in the diagnosis of acute i3. It includes particularly D-lactate, intestinal fatty acid-binding protein (FABP) and citrulline. Herein, we will discuss leading publications concerning these historical markers that point out the main limitations reagrding their use in routine clinical practice. We will also introduce the first and limited results arising from omic studies, underlying the remaining effort that needs to be done in the field of acute i3 biological diagnosis, which remains a challenge.
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Affiliation(s)
- Katell Peoc’h
- Biochimie Clinique, Hôpital Beaujon , Université Paris Diderot, UFR de Médecine Xavier Bichat and APHP, HUPNVS, DHU Unity , Clichy , France
- INSERM, UMRs 1149, CRI , Université Paris Diderot , Paris , France , Phone: +33 (0)1 40 87 54 36
| | - Alexandre Nuzzo
- SURVI, Hôpital Beaujon, APHP, HUPNVS, DHU Unity , Clichy , France
- Gastroenterologie, Hôpital Beaujon, APHP, HUPNVS , Clichy , France
| | - Kevin Guedj
- SURVI, Hôpital Beaujon, APHP, HUPNVS, DHU Unity , Clichy , France
- INSERM, UMRs 1148, LVTS , Paris , France
| | - Catherine Paugam
- Anesthésie Réanimation, Hôpital Beaujon , Université Paris Diderot, UFR de Médecine Xavier Bichat and APHP, HUPNVS , Clichy , France
| | - Olivier Corcos
- SURVI, Hôpital Beaujon, APHP, HUPNVS, DHU Unity , Clichy , France
- Gastroenterologie, Hôpital Beaujon, APHP, HUPNVS , Clichy , France
- INSERM, UMRs 1148, LVTS , Paris , France
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Wang L, Zhao B, Chen Y, Ma L, Chen EZ, Mao EQ. Biliary tract external drainage protects against intestinal barrier injury in hemorrhagic shock rats. World J Gastroenterol 2015; 21:12800-12813. [PMID: 26668504 PMCID: PMC4671035 DOI: 10.3748/wjg.v21.i45.12800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/20/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effects of biliary tract external drainage (BTED) on intestinal barrier injury in rats with hemorrhagic shock (HS).
METHODS: BTED was performed via cannula insertion into the bile duct of rats. HS was induced by drawing blood from the femoral artery at a rate of 1 mL/min until a mean arterial pressure (MAP) of 40 ± 5 mmHg was achieved. That MAP was maintained for 60 min. A total of 99 Sprague-Dawley rats were randomized into a sham group, an HS group and an HS + BTED group. Nine rats in the sham group were sacrificed 0.5 h after surgery. Nine rats in each of the HS and HS + BTED groups were sacrificed 0.5 h, 1 h, 2 h, 4 h and 6 h after resuscitation. Plasma tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and lipopolysaccharide (LPS) levels were analyzed using enzyme-linked immunosorbent assay. Plasma D-lactate levels were analyzed using colorimetry. The expression levels of occludin and claudin-1 in the ileum were analyzed using Western blot and immunohistochemistry. Histology of the ileum was evaluated by hematoxylin and eosin staining.
RESULTS: Plasma TNF-α levels in the HS + BTED group decreased significantly compared with the HS group at 1 h and 6 h after resuscitation (P < 0.05). Plasma IL-6 levels in the HS + BTED group decreased significantly compared with the HS group at 0.5 h, 1 h and 2 h after resuscitation (P < 0.05). Plasma D-lactate and LPS levels in the HS + BTED group decreased significantly compared with the HS group at 6 h after resuscitation (P < 0.05). The expression levels of occludin in the HS + BTED group increased significantly compared with the HS group at 4 h and 6 h after resuscitation (P < 0.05). The expression levels of claudin-1 in the HS + BTED group increased significantly compared with the HS group at 6 h after resuscitation (P < 0.05). Phenomena of putrescence and desquamation of epithelial cells in the ileal mucosa were attenuated in the HS + BTED group. Ileal histopathologic scores in the HS + BTED group decreased significantly compared with the HS group at 2 h, 4 h and 6 h after resuscitation (P < 0.05).
CONCLUSION: BTED protects against intestinal barrier injury in HS rats.
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Télouk P, Puisieux A, Fujii T, Balter V, Bondanese VP, Morel AP, Clapisson G, Lamboux A, Albarede F. Copper isotope effect in serum of cancer patients. A pilot study. Metallomics 2015; 7:299-308. [DOI: 10.1039/c4mt00269e] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Lower65Cu/63Cu ratios in the serum of colorectal and breast cancer patients relative to healthy individuals have potential diagnostic value.
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Affiliation(s)
- Philippe Télouk
- Ecole Normale Supérieure de Lyon
- CNRS and Université Claude Bernard Lyon 1
- Lyon, France
| | - Alain Puisieux
- Centre Léon Bérard and Université Claude Bernard Lyon 1
- Lyon, France
| | - Toshiyuki Fujii
- Research Reactor Institute
- Kyoto University
- Osaka 590-0494, Japan
| | - Vincent Balter
- Ecole Normale Supérieure de Lyon
- CNRS and Université Claude Bernard Lyon 1
- Lyon, France
| | - Victor P. Bondanese
- Ecole Normale Supérieure de Lyon
- CNRS and Université Claude Bernard Lyon 1
- Lyon, France
| | | | - Gilles Clapisson
- Centre Léon Bérard and Université Claude Bernard Lyon 1
- Lyon, France
| | - Aline Lamboux
- Ecole Normale Supérieure de Lyon
- CNRS and Université Claude Bernard Lyon 1
- Lyon, France
| | - Francis Albarede
- Ecole Normale Supérieure de Lyon
- CNRS and Université Claude Bernard Lyon 1
- Lyon, France
- Department of Earth Sciences
- Houston, USA
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Collange O, Tamion F, Meyer N, Quillard M, Kindo M, Hue G, Veber B, Dureuil B, Plissonnier D. Early detection of gut ischemia-reperfusion injury during aortic abdominal aneurysmectomy: a pilot, observational study. J Cardiothorac Vasc Anesth 2013; 27:690-5. [PMID: 23731714 DOI: 10.1053/j.jvca.2013.01.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE D-lactate is the enantiomer of L-lactate, which is measured routinely in clinical practice to assess cell hypoxia. D-lactate has been proposed as a specific marker of gut ischemia-reperfusion (IR), particularly during surgery for ruptured abdominal aortic aneurysms. The aim of this study was to compare the use of D-lactate measurement and colonic tonometry (taken as a reference method) for gut IR detection during elective infrarenal aortic aneurysm (IrAA) surgery. DESIGN Prospective, monocenter, observational study. SETTING Vascular surgery unit, university hospital. PARTICIPANTS Candidates for elective IrAA surgery. INTERVENTIONS Patients without (controls) and with gut IR (defined as ΔCO2>2.6 kPa) were compared retrospectively. MEASUREMENT AND MAIN RESULTS D-lactate levels were compared with colonic perfusion levels (ΔCO2), as assessed by colonic tonometry, at 7 time points during surgery and until 24 hours after surgery. D-lactate also was measured in mesenteric vein blood before and after gut reperfusion. Plasma TNF-α level was measured at the same time points to assess systemic inflammatory response. Eighteen patients requiring elective IrAA surgery were included. The ΔCO2 and TNF-α level varied significantly over time. There was a significant ΔCO2 peak at the end of clamping (2.6±1.8 kPa, p = 0.006) and a significant peak in TNF-α level after 1 hour of reperfusion (183±53 ng/L, p = 0.05). D-lactate levels were undetectable in systemic and mesenteric blood in all the patients throughout the study period. Gut IR patients (n = 6) experienced a longer overall duration of intraoperative hypotensive episodes and received more catecholamines than the controls (n = 12). CONCLUSIONS Compared with colonic tonometry, D-lactate was not a reliable biomarker of gut IR during elective IrAA surgery.
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Affiliation(s)
- Olivier Collange
- Pôle Anesthésie, Réanimation Chirurgicale, SAMU, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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Huang TC, Chen SM, Li YC, Lee JA. Urinaryd-lactate levels reflect renal function in aristolochic acid-induced nephropathy in mice. Biomed Chromatogr 2013; 27:1100-6. [DOI: 10.1002/bmc.2908] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 02/25/2013] [Accepted: 02/25/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Tzu-Chuan Huang
- School of Pharmacy, College of Pharmacy; Taipei Medical University; No. 250, Wuxing St; Taipei; 11031; Taiwan
| | - Shih-Ming Chen
- School of Pharmacy, College of Pharmacy; Taipei Medical University; No. 250, Wuxing St; Taipei; 11031; Taiwan
| | - Yi-Chieh Li
- School of Pharmacy, College of Pharmacy; Taipei Medical University; No. 250, Wuxing St; Taipei; 11031; Taiwan
| | - Jen-Ai Lee
- School of Pharmacy, College of Pharmacy; Taipei Medical University; No. 250, Wuxing St; Taipei; 11031; Taiwan
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Borthwick HA, Brunt LK, Mitchem KL, Chaloner C. Does lactate measurement performed on admission predict clinical outcome on the intensive care unit? A concise systematic review. Ann Clin Biochem 2012; 49:391-4. [PMID: 22715295 DOI: 10.1258/acb.2011.011227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background There is a need for practical, efficient and effective prognostic markers for patients admitted to the intensive care unit (ICU) with sepsis, to identify patients at highest risk and guide and monitor treatment. Although many biomarkers and scoring systems have been advocated, none have yet achieved this elusive combination. Most ICUs already use blood lactate concentrations to monitor patients but the evidence base for this application is unclear. Methods A systematic review of the last five years of evidence of effectiveness of lactate measurement in prediction of outcome in ICUs was performed. Results It was found that there is a lack of high-quality evidence, and no specific studies of prognostic accuracy. d- or l-Lactate concentrations measured in plasma, serum, whole blood or colonic washings were raised at admission in almost all patient groups, and were higher in patient groups who had the worst outcomes (in-hospital mortality, sequential organ failure). However, there was significant overlap in individual concentrations measured in those who died within 28 days of admission, or who developed multiple organ failure, and those who did not. For serum l-lactate concentrations, no specific cut-off value capable of predicting in-hospital mortality or sequential organ failure could be recommended. Conclusions The evidence reviewed suggested that whole blood, plasma or serum lactate measurement could not provide specific prognostic information for individual patients. There may be a role for monitoring for normalization of serum d- or l-lactate concentrations during goal-directed therapy in the ICU but further good-quality studies are needed. Measurement of the d-lactate stereoisomer shows promise, such that further studies are warranted.
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Affiliation(s)
- Hazel-Ann Borthwick
- Department of Clinical Biochemistry, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Hollyhurst Road, Durham DL3 6HX
| | - Lorraine K Brunt
- Clinical Chemistry, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF
| | - Kelly L Mitchem
- Prince Charles Hospital, Cwm Taf NHS Health Board, Merthyr Tydfil CF47 9DT
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Nielsen C, Mortensen FV, Erlandsen EJ, Lindholt JS. l- and d-lactate as biomarkers of arterial-induced intestinal ischemia: An experimental study in pigs. Int J Surg 2012; 10:296-300. [DOI: 10.1016/j.ijsu.2012.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 05/02/2012] [Accepted: 05/08/2012] [Indexed: 12/22/2022]
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Abstract
OBJECTIVE To evaluate the association between peritoneal fluid and plasma d-lactate concentration with variables used in the diagnosis and prognosis of horses with colic. ANIMALS Clinically healthy horses (n=6) and 90 horses with colic. STUDY DESIGN Prospective cross-sectional study. METHODS D-lactate concentration was determined in peritoneal fluid and plasma of all horses. Information on other blood and peritoneal fluid variables, signalment, results from the physical examination, outcome, need for surgery, lesion location, and type was retrieved from medical records. RESULTS Peritoneal D-lactate concentration was strongly correlated with plasma D-lactate concentration (r=0.71; P<.001). Peritoneal and plasma D-lactate concentrations were positively correlated with peritoneal (r=0.8; P<.001) and plasma L-lactate (r=0.33; P=.001) concentrations, respectively. Peritoneal D-lactate concentration was negatively correlated with survival to discharge (U=430.5; P<.001). Median peritoneal D-lactate concentration of horses with septic peritonitis (455.2 μmol/L) and horses with gastrointestinal rupture (599.5 μmol/L) were higher compared with horses with nonstrangulating obstructions (77.7 μmol/L). A cut-off concentration of peritoneal D-lactate of 116.6 μmol/L had a sensitivity of 0.813 and a specificity of 0.651 to differentiate between nonstrangulating and strangulating obstructions. CONCLUSIONS Peritoneal D-lactate concentration may be more useful for identifying horses with strangulating obstructions (high sensitivity, low probability of a false negative) than to ruling out strangulating obstruction (moderate specificity, high probability of a false positive).
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Affiliation(s)
- Sawsan Z Yamout
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA 95616, USA
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Abstract
BACKGROUND Although blood lactate concentrations have an established prognostic value in circulatory shock or after cardiac arrest, their relationship with morbidity and length of stay in general intensive care unit (ICU) populations has not been well defined. METHODS This study included all 433 patients (246 surgical and 187 medical) consecutively admitted to the Department of medico-surgical intensive care. Hyperlactataemia was defined as a serum lactate concentration > or = 2 mEq/l. RESULTS On admission, 195 patients (45%) had hyperlactataemia. Hyperlactataemic patients had higher Acute Physiology and Chronic Health Evaluation (APACHE) II (13.3 +/- 6.9 vs 10.0 +/- 5.2) and Sequential Organ Failure Assessment (SOFA) (5.3 +/- 3.3 vs 3.3 +/- 2.3) scores than patients with normal lactate concentrations (both p < 0.01). There was no overall difference in length of ICU stay (LOS) between the two groups but survivors in the hyperlactataemic group had a longer LOS than survivors in the normal lactate group, whereas hyperlactataemic non-survivors had a shorter LOS than normal lactate non-survivors. Mortality was 9% in patients with normal lactate concentrations and 23% in hyperlactataemic patients. The mortality rate increased with increasing lactate concentrations, from 17% in patients with lactate concentrations from 2-4 mEq/l to 64% in those with concentrations more than 8 mEq/l. Non-survivors had higher lactate concentrations than survivors on admission, and after 24 and 48 hours. Risk factors for developing hyperlactataemia that were present on admission were SOFA score > 5, mean arterial blood pressure less than 70 mmHg, blood sugar greater than 110 mg/dl, and current use of vasopressors. CONCLUSIONS Our study documents a direct relationship between the serum lactate level on ICU admission and not only the risk of death in ICU but also the length of ICU stay. Hyperlactataemic survivors have a longer LOS and non-survivors a shorter LOS than normal lactate survivors and non-survivors, respectively.
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Affiliation(s)
- H M Soliman
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium
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15
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Becker JU, Theodosis C, Jacob ST, Wira CR, Groce NE. Surviving sepsis in low-income and middle-income countries: new directions for care and research. Lancet Infect Dis 2009; 9:577-82. [PMID: 19695494 DOI: 10.1016/s1473-3099(09)70135-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sepsis is a disorder characterised by systemic inflammation secondary to infection. Despite recent progress in the understanding and treatment of sepsis, no data or recommendations exist that detail effective approaches to sepsis care in resource-limited low-income and middle-income countries (LMICs). Although few data exist on the burden of sepsis in LMICs, the prevalence of HIV and other comorbid conditions in some LMICs suggest that sepsis is a substantial contributor to mortality in these regions. In well-resourced countries, sepsis management relies on protocols and complex invasive technologies not widely available in most LMICs. However, the key concepts and components of sepsis management are potentially translatable to resource-limited environments. Health personnel in LMICs should be educated in the recognition of sepsis and the importance of early and appropriate antibiotic use. Simple and low-cost standardised laboratory testing should be emphasised to allow accurate diagnosis, prognosis, and monitoring of treatment response. Evidence-based interventions and treatment algorithms tailored to LMIC ecology and resources should thus be developed and validated.
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Affiliation(s)
- Joseph U Becker
- Section of Emergency Medicine, Department of Surgery, Yale University School of Medicine, New Haven, CT 06519, USA.
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16
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Abstract
Septic shock is characterised by vasodilation, myocardial depression and impaired microcirculatory blood flow, resulting in redistribution of regional blood flow. Animal and human studies have shown that gastrointestinal mucosal blood flow is impaired in septic shock. This is consistent with abnormalities found in many other microcirculatory vascular beds. Gastrointestinal mucosal microcirculatory perfusion deficits have been associated with gut injury and a decrease in gut barrier function, possibly causing augmentation of systemic inflammation and distant organ dysfunction. A range of techniques have been developed and used to quantify these gastrointestinal perfusion abnormalities. The following techniques have been used to study gastrointestinal perfusion in humans: tonometry, laser Doppler flowmetry, reflectance spectrophotometry, near-infrared spectroscopy, orthogonal polarisation spectral imaging, indocyanine green clearance, hepatic vein catheterisation and measurements of plasma D-lactate. Although these methods share the ability to predict outcome in septic shock patients, it is important to emphasise that the measurement results are not interchangeable. Different techniques measure different elements of gastrointestinal perfusion. Gastric tonometry is currently the most widely used technique because of its non-invasiveness and ease of use. Despite all the recent advances, the usefulness of gastrointestinal perfusion parameters in clinical decision-making is still limited. Treatment strategies specifically aimed at improving gastrointestinal perfuision have failed to actually correct mucosal perfusion abnormalities and hence not shown to improve important clinical endpoints. Current and future treatment strategies for septic shock should be tested for their effects on gastrointestinal perfusion; to further clarify its exact role in patient management, and to prevent therapies detrimental to gastrointestinal perfusion being implemented.
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Affiliation(s)
- F M P van Haren
- Intensive Care Department, Waikato Hospital, Hamilton, New Zealand
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17
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Abstract
This review summarizes key research papers published in the fields of cardiology and intensive care during 2006 in Critical Care and, where relevant, in other journals within the field. The papers have been grouped into categories: haemodynamic monitoring, vascular access in intensive care, microvascular assessment and manipulation, and impact of metabolic acidosis on outcome.
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Affiliation(s)
- Nawaf Al-Subaie
- General Intensive Care Unit, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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18
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Abstract
In the critically ill, metabolic acidosis is a common observation and, in clinical practice, the cause of this derangement is often multi-factorial. Various measures are often employed to try and characterise the aetiology of metabolic acidosis, the most popular of which is the anion gap. The purpose of the anion gap can be perceived as a means by which the physician is alerted to the presence of unmeasured anions in plasma that contribute to the observed acidosis. In many cases, the causative ion may be easily identified, such as lactate, but often the causative ion(s) remain unidentified, even after exclusion of the 'classic' causes. We describe here the various attempts in the literature that have been made to address this observation and highlight recent studies that reveal potential sources of such hitherto unmeasured anions.
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Affiliation(s)
- Lui G Forni
- Department of Critical Care, Worthing Hospital, Worthing, West Sussex BN11 2DH, UK.
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