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• Research Paper Volume 11, Issue 13 pp 4446-4462

  Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study

  Relevance score: 23.01751

  Feng Gao, Xie-lin Huang, Meng-Xing Cai, Miao-tong Lin, Bin-feng Wang, Wei Wu, Zhi-Ming Huang

  Keywords: lactate, lactate clearance, cirrhosis, acute-on-chronic liver failure, mortality

  Published in Aging on July 1, 2019

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  Lactate clearance (Δ24Lac) was reported to be inversely associated with mortality in critically ill patients. The aim of our study was to assess the value of Δ24Lac for the prognosis of critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF). We analysed 954 cirrhotic patients with hyperlactatemia admitted to intensive care units (ICUs) in the United States and eastern China. The patients were followed up for at least 1 year. In the unadjusted model, we observed a 15% decrease in hospital mortality with each 10% increase in Δ24Lac. In the fully adjusted model, the relationship between the risk of death and Δ24Lac remained statistically significant (hospital mortality: odds ratio [OR] 0.84, 95% confidence interval [CI]: 0.78- 0.90, p < 0.001; 90-day mortality: hazard ratio [HR] 0.94, 95%CI 0.92- 0.97, p < 0.001; for Δ24Lac per 10% increase). Similar results were found in patients with ACLF. We developed a Δ24Lac-adjusted score (LiFe-Δ24Lac), which performed significantly better in the area under the receiver operating characteristic curves (AUROCs) than the original LiFe score for predicting mortality. Lactate clearance is an independent predictor of death, and the LiFe-Δ24Lac score is a practical tool for stratifying the risk of death.

  

  Kaplan-Meier curves stratified by Δ24Lac quartiles. The curves showed different the cumulative survival rates of patients with different Δ24Lac levels. (A): cirrhotic patients. (B): ACLF patients.

  
  
  

  

  AUROCs for LiFe-Δ24Lac, CLIF-C ACLF and LiFe scores in prediction of mortality in patients with cirrhosis and ACLF in the derivation and validation cohort. Cirrhosis patients, MIMIC cohort: 28-day mortality (A); 90-day mortality (B); eICU cohort: hospital mortality (C); WMU cohort: 28-day mortality (D); 90-day mortality (E). ACLF patients: MIMIC cohort: 28-day mortality (F); 90-day mortality (G); eICU cohort: hospital mortality (H). WMU cohort: 28-day mortality (I); 90-day mortality (J).

  
  
  

  

  A flow diagram of study participants (derivation cohort).