Hyperlactataemia is commonly used as a diagnostic and prognostic tool in intensive care settings. Recent studies documented that serial lactate measurements over time (or lactate clearance), may be clinically more reliable than lactate absolute value for risk stratification in different pathological conditions. While the negative prognostic role of hyperlactataemia in several critical ill diseases (such as sepsis and trauma) is well established, data in patients with acute cardiac conditions (i.e. acute coronary syndromes) are scarce and controversial. The present paper provides an overview of the current available evidence on the clinical role of lactic acid levels and lactate clearance in acute cardiac settings (acute coronary syndromes, cardiogenic shock, cardiac surgery), focusing on its prognostic role.
WatsonNCHeardOS. The use of lactate as a biomarker. J Intensive Care Med2010; 25(5): 301–302.
2.
LeverveXM. Lactate in the intensive care unit: pyromaniac, sentinel or fireman?Critical Care2005; 6: 622–623.
3.
VernonCLe TourneauJL. Lactic acidosis: recognition, kinetics and associated prognosis. Crit Care Clin2006; 26: 255–283.
4.
RiversENguyenBHavstadS. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med2001; 345: 1368–1377.
5.
JunejaDSinghODangR. Admission hyperlactatemia: causes, incidence, and impact on outcome of patients admitted in a general medical intensive care unit. J Crit Care2011; 26(3): 316–320.
6.
HenningRJWeilMHWeinerF. Blood lactate as prognostic indicator of survival in patients with acute myocardial infarction. Circ Shock1982; 9(3): 307–315.
7.
LazzeriCValenteSChiostriM. Lactate in the acute phase of ST-elevation myocardial infarction treated with mechanical revascularization: a single-center experience. Am J Emerg Med2012; 30(1): 92–96.
8.
LevyB. Lactate and shock state: the metabolic view. Curr Opin Crit Care2006; 12(4): 315–321.
9.
LeverveXMMustafaI. Lactate: a key metabolite in the intracellular metabolic interplay. Critical Care2002; 6(4): 284–285.
10.
GladdenLB. Lactate metabolism: a new paradigm for the third millennium. J Physiol2004; 558(Pt 1): 5–30.
11.
ValenzaFAlettiGFossaliT. Lactate as a marker of energy failure in critically ill patients: hypotesis. Critical Care2005; 9(6): 588–593.
GutierrezGWulfME. Lactic acidosis in sepsis: a commentary. Intensive Care Med1996; 22: 6–16.
14.
JamesJHLuchetteFAMcCarterFD: Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis. Lancet1999; 354: 505–508.
15.
MizockBAFalkJL. Lactic acidosis in critical illness. Crit Care Med1992; 20: 80–93.
16.
De BackerDCreteurJDuboisMJ. The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its sistemic effects. Crit Care Med2006, 34: 403–408.
17.
NicholADEgiMPettilaV. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care2010; 14: R25.
18.
DukeTDButtWSouthM. Predictors of mortality and multiple organ failure in children with sepsis. Intensive Care Med1997; 23(6): 684–692.
19.
KhosravaniHShahporiRStelfoxHT. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit Care2009; 13(3): R90.
20.
SinghalRCoghillJEGuyA. Serum lactate and base deficit as predictors of mortality after ruptured abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg2005; 30(3): 263–266.
21.
SchmiechenNJHanCMilzmanDP. ED use of rapid lactate to evaluate patients with acute chest pain. Ann Emerg Med1997; 30: 571–577.
22.
MavrićZZaputovićLZagarD. Usefulness of blood lactate as a predictor of shock development in acute myocardial infarction. Am J Cardiol1991; 67(9): 912.
23.
GatienMStiellIWielgoszA. Diagnostic performance of venous lactate on arrival at the emergency department for myocardial infarction. Acad Emerg Med2005; 12: 106–113.
24.
VermeulenRPHoekstraMNijstenMW. Clinical correlates of arterial lactate levels in STEMI patients at admission: a descriptive study. Crit Care2010; 14: R164.
25.
LazzeriCSoriAChiostriM. Prognostic role of insulin resistance as assessed by homeostatic model assessment index in the acute phase of myocardial infarction in nondiabetic patients submitted to percutaneous coronary intervention. Eur J Anaesthesiol2009; 26(10): 856–862.
26.
WeilMHAfifiAA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation1970; 41: 989–1001.
27.
MüllnerMSterzFDomanovitsH. The association between blood lactate concentration on admission, duration of cardiac arrest, and functional neurological recovery in patients resuscitated from ventricular fibrillation. Intensive Care Med1997; 23(11): 1138–1143.
28.
ValenteSLazzeriCVecchioS. Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock. Int J Cardiol2007; 114(2): 176–182.
29.
EnglehartMSSchreiberMA. Measurement of acid-base resuscitation endpoints: lactate, base deficit, bicarbonate or what?Curr Opin Crit Care2006; 12: 569–574.
30.
RaperRFCameronGWalkerD. Type B lactic acidosis following cardiopulmonary bypass. Crit Care Med1997; 25: 46–51.
31.
HabibRHZachariasASchwannTA. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed?J Thorac Cardiovasc Surg2003; 125: 1438–1450.
32.
RanucciMDe ToffolBIsgròG. Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative out-come. Critical Care2006; 10: R167.
33.
KapoorPMandalBChowdhuryU. Changes in myocardial lactate, pyruvate and lactate-pyruvate ratio during cardiopulmonary bypass for elective adult cardiac surgery: early indicator of morbidity. J Anaesthesiol Clin Pharmacol2011; 27(2): 225–232.
34.
MailletJMLe BesneraisPCantoniM. Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest2003; 123: 1361–1366.
35.
RochaTSSilveiraASBottaAM. Serum lactate as mortality and morbidity marker in infants after Jatene’s operation. Rev Bras Cir Cardiovasc2010; 25(3): 350–358.
36.
LevrautJCiebieraJPChaveS. Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction. Am J Resp Crit Care Med1998; 157(4Pt 1): 1021–1026.
37.
BellomoR. Bench-to-bedside review: lactate and the kidney. Crit Care2002; 6(4): 322–326.
38.
BakkerJGrisPCoffernilsM. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg1996; 171: 221–226.
39.
AbramsonDScaleaTMHitchcockR. Lactate clearance and survival following injury. J Trauma1993; 35: 584–589.
40.
VincentJLDufayePBerréJ. Serial lactate determinations during circulatory shock. Crit Care Med1983; 11: 449–451.
41.
JonesAEShapiroNITrzeciakS. Emergency Medicine Shock Research Network (EMShockNet) Investigators. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA2010; 303(8): 739–746.
42.
MeregalliAOliveiraRPFriedmanG. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high risk, surgical patients. Crit Care2004; 8: R60–R65.
43.
NguyenHBRiversEPKnoblichBP: Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med2004; 32: 1637–1642.
44.
NguyenHBRiversEPKnoblichBP. Early lactate clearance is associated with biomarkers of inflammation, coagulation, apoptosis, organ disfunction and mortality in severe sepsis and septic shock. J Inflamm2010; 7: 6.
45.
ArnoldRCShapiroNIJonesAE. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock2009; 32: 35–39.
46.
McNelisJMariniCPJurkiewiczA. Prolonged lactate clearance is associated with increate mortality in the surgical intensive care unit. Am J Surg2001; 182(5): 481–485.
47.
SolimanHMVincentJL. Prognostic value of admission serum lactate concentrations in intensive care unit patients. Acta Clin Belg2010; 65(3): 176–181.
48.
Den UilCACaliskanKLagrandWK. Dose-dependent benefit of nitroglycerin on microcirculation of patients with severe heart failure. Intensive Care Med2009; 35: 1893–1899.
49.
KliegelALosertHSterzF. Serial lactate determination for prediction of outcome after cardiac arrest. Medicine2004; 83: 274–279.
50.
JansenT.CBommelJVBakkerJ. Blood lactate monitoring in critically ill patients: a systematic health technology assessment. Crit Care Med2009; 37(10): 2827–2839.
51.
AttanàPLazzeriCChiostriM. Lactate clearance in cardiogenic shock following ST elevation myocardial infarction: a pilot study. Acute Card Care2012; 14(1): 20–26.
