Critical Care (Oct 2017)
Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis
- Namkje A. R. Vellinga,
- E. Christiaan Boerma,
- Matty Koopmans,
- Abele Donati,
- Arnaldo Dubin,
- Nathan I. Shapiro,
- Rupert M. Pearse,
- Peter H. J. van der Voort,
- Arjen M. Dondorp,
- Tony Bafi,
- Michael Fries,
- Tulin Akarsu-Ayazoglu,
- Andrius Pranskunas,
- Steven Hollenberg,
- Gianmarco Balestra,
- Mat van Iterson,
- Farid Sadaka,
- Gary Minto,
- Ulku Aypar,
- F. Javier Hurtado,
- Giampaolo Martinelli,
- Didier Payen,
- Frank van Haren,
- Anthony Holley,
- Hernando Gomez,
- Ravindra L. Mehta,
- Alejandro H. Rodriguez,
- Carolina Ruiz,
- Héctor S. Canales,
- Jacques Duranteau,
- Peter E. Spronk,
- Shaman Jhanji,
- Sheena Hubble,
- Marialuisa Chierego,
- Christian Jung,
- Daniel Martin,
- Carlo Sorbara,
- Jan Bakker,
- Can Ince,
- for the microSOAP study group
Affiliations
- Namkje A. R. Vellinga
- Department of Intensive Care Adults, Erasmus MC University Medical Center
- E. Christiaan Boerma
- Department of Intensive Care, Medical Center Leeuwarden
- Matty Koopmans
- Department of Intensive Care, Medical Center Leeuwarden
- Abele Donati
- Department of Biomedical Science and Public Health, Università Politecnica delle Marche
- Arnaldo Dubin
- Sanatorio Otamendi y Miroli, Servicio de Terapia Intensiva
- Nathan I. Shapiro
- Department of Emergency Medicine and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center
- Rupert M. Pearse
- Barts and The London School of Medicine and Dentistry
- Peter H. J. van der Voort
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis
- Arjen M. Dondorp
- Faculty of Tropical Medicine, Mahidol University
- Tony Bafi
- Dor e Terapia Intensiva, Universidade Federal de São Paolo
- Michael Fries
- Department of Anesthesia and Surgical Intensive Care, St. Vincenz Krankenhaus
- Tulin Akarsu-Ayazoglu
- S.B. Medeniyet University Göztepe Education and Research Hospital Kadıköy
- Andrius Pranskunas
- Intensive Care Department, Lithuanian University of Health Sciences
- Steven Hollenberg
- Section of Cardiology, Cooper University Hospital
- Gianmarco Balestra
- Medical Intensive Care Unit, University Hospital Basel
- Mat van Iterson
- Department of Anesthesiology, Intensive Care and Pain Management, St. Antonius Hospital
- Farid Sadaka
- Critical Care Medicine/Neurocritical Care, Mercy Hospital St. Louis, St. Louis University Hospital
- Gary Minto
- Derriford Hospital, Plymouth University Peninsula School of Medicine
- Ulku Aypar
- Intensive Care Unit, Hacettepe University
- F. Javier Hurtado
- Intensive Care Unit, Hospital Español-State Health Administration Service, School of Medicine, University of the Republic
- Giampaolo Martinelli
- Department of Perioperative Medicine, Barts Heart Centre, St. Bartholomew’s Hospital
- Didier Payen
- Department of Anesthesiology, Critical Care and Mobile Emergency and Resuscitation Service (SMUR), Hôpital Lariboisière Assistance Publique – Hôpitaux de Paris (AP-HP)/Université Paris 7 Diderot
- Frank van Haren
- Intensive Care Unit, Canberra Hospital
- Anthony Holley
- Department of Intensive Care Medicine, Royal Brisbane & Women’s Hospital
- Hernando Gomez
- Critical Care Medicine, University of Pittsburgh
- Ravindra L. Mehta
- School of Medicine, University of California, San Diego
- Alejandro H. Rodriguez
- Critical Care Department, Joan XXIII University Hospital
- Carolina Ruiz
- Departamento de Medicina Intensiva, Escuela de Medicina, Facultad de Medicina, Universidad Católica de Chile
- Héctor S. Canales
- Intensive Care Unit, Hospital San Martín
- Jacques Duranteau
- Departement d’Anesthesie-Reanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre Assistance Publique – Hôpitaux de Paris (AP-HP)
- Peter E. Spronk
- Intensive Care Unit, Gelre Ziekenhuizen
- Shaman Jhanji
- Intensive Care Unit, The Royal Marsden Hospital
- Sheena Hubble
- Intensive Care Unit, Royal Devon and Exeter Hospital
- Marialuisa Chierego
- Intensive Care Unit, Santa Maria degli Angeli Hospital
- Christian Jung
- Department of Cardiology, Universitätsherzzentrum Thüringen, Clinic of Internal Medicine I, Friedrich Schiller University Jena
- Daniel Martin
- Intensive Care Unit, Royal Free Hospital
- Carlo Sorbara
- Dipartimento di Anestesia, Rianimazione e Terapia Intensiva, Azienda Unità Locale Socio Sanitaria 9 (ULSS 9) Veneto
- Jan Bakker
- Department of Intensive Care Adults, Erasmus MC University Medical Center
- Can Ince
- Department of Intensive Care Adults, Erasmus MC University Medical Center
- for the microSOAP study group
- DOI
- https://doi.org/10.1186/s13054-017-1842-7
- Journal volume & issue
-
Vol. 21,
no. 1
pp. 1 – 9
Abstract
Abstract Background Mildly elevated lactate levels (i.e., 1–2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to evaluate the association between relative hyperlactatemia, microcirculatory flow, and outcome. Methods This study was a predefined subanalysis of a multicenter international point prevalence study on microcirculatory flow abnormalities, the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Microcirculatory flow abnormalities were assessed with sidestream dark-field imaging. Abnormal microcirculatory flow was defined as a microvascular flow index (MFI) 1.5 mmol/L was independently associated with a MFI < 2.6 (OR 2.5, 95% CI 1.1–5.7, P = 0.027). Conclusions In a heterogeneous ICU population, a single-spot mildly elevated lactate level (even within the reference range) was independently associated with increased mortality and microvascular flow abnormalities. In vivo microscopy of the microcirculation may be helpful in discriminating between flow- and non-flow-related causes of mildly elevated lactate levels. Trial registration ClinicalTrials.gov, NCT01179243 . Registered on August 3, 2010.
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