Understanding lactatemia in human sepsis potential impact for early management

Luciano Gattinoni, Francesco Vasques, Luigi Camporota, Jennifer Meessen, Federica Romitti, Iacopo Pasticci, Eleonora Duscio, Francesco Vassalli, Lui G. Forni, Didier Payen, Massimo Cressoni, Alberto Zanella, Roberto Latini, Michael Quintel, John J. Marini

Research output: Contribution to journalArticle

Abstract

Rationale: Hyperlactatemia in sepsis may derive from a prevalent impairment of oxygen supply/demand and/or oxygen use. Discriminating between these two mechanisms may be relevant for the early fluid resuscitation strategy. Objectives: To understand the relationship among central venous oxygen saturation (ScvO2), lactate, and base excess to better determine the origin of lactate. Methods: This was a post hoc analysis of baseline variables of 1,741 patients with sepsis enrolled in the multicenter trial ALBIOS (Albumin ItalianOutcome Sepsis). Variableswere analyzed as a function of sextiles of lactate concentration and sextiles of ScvO2.Wedefined the "alactic base excess," as the sum of lactate and standard base excess. Measurements and Main Results: Organ dysfunction severity scores, physiologic variables of hepatic, metabolic, cardiac, and renal function, and 90-day mortality were measured. ScvO2 was lower than 70% only in 35% of patients. Mortality, organ dysfunction scores, and lactate were highest in the first and sixth sextiles of ScvO2. Although lactate level related strongly to mortality, it was associated with acidemia only when kidney function was impaired (creatinine >2 mg/dl), as rapidly detected by a negative alactic base excess. In contrast, positive values of alactic base excess were associated with a relative reduction of fluid balance. Conclusions: Hyperlactatemia is powerfully correlated with severity of sepsis and, in established sepsis, is caused more frequently by impaired tissue oxygen use, rather than by impaired oxygen transport. Concomitant acidemia was only observed in the presence of renal dysfunction, as rapidly detected by alactic base excess. The current strategy of fluid resuscitation could be modified according to the origin of excess lactate.

Original languageEnglish
Pages (from-to)582-589
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume200
Issue number5
DOIs
Publication statusPublished - Sep 1 2019

Keywords

  • Base excess
  • Lactic acidosis
  • Sepsis
  • Venous oxygen saturation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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  • Cite this

    Gattinoni, L., Vasques, F., Camporota, L., Meessen, J., Romitti, F., Pasticci, I., Duscio, E., Vassalli, F., Forni, L. G., Payen, D., Cressoni, M., Zanella, A., Latini, R., Quintel, M., & Marini, J. J. (2019). Understanding lactatemia in human sepsis potential impact for early management. American Journal of Respiratory and Critical Care Medicine, 200(5), 582-589. https://doi.org/10.1164/rccm.201812-2342OC