Critical Care (Aug 2017)

The association of early combined lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients

  • Pedro Freire Jorge,
  • Nienke Wieringa,
  • Eva de Felice,
  • Iwan C. C. van der Horst,
  • Annemieke Oude Lansink,
  • Maarten W. Nijsten

DOI
https://doi.org/10.1186/s13054-017-1785-z
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 11

Abstract

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Abstract Background The development of renal and liver dysfunction may be accompanied by initially subtle derangements in the gluconeogenetic function. Discrepantly low glucose levels combined with high lactate levels might indicate an impaired Cori cycle. Our objective was to examine the relation between early lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients. Methods Over a 4-year period (2011 to 2014), all adult patients admitted to our adult 48-bed teaching hospital intensive care unit (ICU) for at least 12 h were retrospectively analyzed. Lactate and glucose were regularly measured with point-of-care analyzers in all ICU patients. Lactate and glucose measurements were collected from 6 h before to 24 h after ICU admission. Patients with fewer than four lactate/glucose measurements were excluded. Patients received insulin according to a computer-guided control algorithm that aimed at a glucose level 2.3 mmol/L) and glucose quintiles (≤7.0; 7.0–7.6; 7.6–8.2; 8.2–9.0; >9.0 mmol/L) were related with outcome in univariate analysis (p < 0.001). Acute Physiology and Chronic Health Evaluation (APACHE) IV, lactate, and glucose were associated with renal and liver dysfunction in multivariate analysis (p < 0.001), with a U-shaped relationship for glucose. The combination of the highest lactate quintile with the lowest glucose quintile was associated with the highest rates of renal dysfunction, liver dysfunction, and mortality (p < 0.001) with a significant interaction between lactate and glucose (p ≤ 0.001). Conclusions Abnormal combined lactate and glucose measurements may provide an early indication of organ dysfunction. In critically ill patients a ‘normal’ glucose with an elevated lactate should not be considered desirable, as this combination is related with increased mortality.

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