Lactate Clearance Is a Useful Biomarker for the
Prediction of All-Cause Mortality in Critically Ill
Patients: A Systematic Review and Meta-Analysis

Zhongheng Zhang, MM; Xiao Xu, MB Critical Care Medicine September 2014 • Volume 42 • Number 9

In the critically ill patient production of lactate rises dramatically. Studies confirm that tissue hypoxia is a cause of lactate increase.

Initial lactate levels of more than 4 mmol/l have been associated with substantial increases in mortality (Trzeciak S, Dellinger RP, Chansky ME, et al:  Intensive Care Med 2007; 33:970–977).

However a single measurement of lactate is a static variable and to make it more useful a trend, lactate clearance, needs to explored.

This review aims to establish that lactate clearance was of good prognostic performance in predicting mortality.

15 citations included in the final analysis.

Overall mortality varied from 7.2% to 72.5% with most studies defining lactate clearance as reduction within 6 hours. Magnitude of reduction varied from 10% to 50%.

Relative risk of death associated with lactate clearance was calculated and in sepsis this was 0.41. In order to understand relative risk I think you will find the video below very useful. My understanding is that because the relative risk figure is less than one that the relative risk of death in those patients with a lactate clearance is reduced compared to those patients without a lactate clearance.

All studies showed that a higher lactate clearance was associated with lower risk of death with relative risk ranging from 0.04 to 0.57.

Conclusion is that lactate clearance is a strong predictor of survival, only of moderate diagnostic performance in predicting mortality and it is of limited value in the patient with sepsis or septic shock!

Study limited by significant hetrogeneity. Making some allowance for this the diagnostic performance of lactate clearance in predicting mortality was best in ICU patients.

“study demonstrates that higher LC is predictive of lower mortality in critically ill patients, supporting the notion that resuscitation bundles involving LC may significantly improve patients’ clinical outcome. Furthermore, the clinical value of LC is not restricted to patients with sepsis or septic shock, but it is of great usefulness in critically ill patients without evident circulatory shock. Elevated lactate is a harbinger of adverse clinical outcome, and its rapid clearance is universally associated with improved outcome in heterogeneous ICU or ED patient population”

Jones article on Lacate Clearance

See also Rivers Trial on this web site

Also read about the debate about whether lactate clearance is a valid parameter.

EMCRITS view on the above

Listen to Stitcher

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Originally posted 2014-08-27 14:42:11. Republished by Blog Post Promoter

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