Sympathetic stimulation increases serum lactate concentrations in patients admitted with sepsis: implications for resuscitation strategies

Annals of Intensive Care

Mark A. Malesker¹  Tej M. Patel²  Ryan W. Walters³  Douglas R. Moore⁴  Nikhil Jagan⁴  Robert W. Plambeck⁴  Lee E. Morrow⁵ 

[1] Creighton University School of Pharmacy and Health Professions, Omaha, USA;Department of Internal Medicine, Washington University School of Medicine, St. Louis, USA;Division of Clinical Research & Evaluative Sciences, Creighton University School of Medicine, Omaha, USA;Division of Pulmonary & Critical Care, Creighton University School of Medicine, 7710 Mercy Road, Suite 410, 68124, Omaha, NE, USA;Division of Pulmonary & Critical Care, Creighton University School of Medicine, 7710 Mercy Road, Suite 410, 68124, Omaha, NE, USA;VA Nebraska-Western Iowa, Section of Pulmonary and Critical Care, Omaha, USA;

关键词: Sepsis;    Lactic acid;    Shock;    Critical care outcomes;    Resuscitation;    Prognosis;   

DOI  :  10.1186/s13613-021-00805-9

来源: Springer

【 摘 要 】

BackgroundDiametrically opposed positions exist regarding the deleterious effects of elevated lactate. There are data suggesting that it is a detrimental proxy for tissue hypoperfusion and anaerobic metabolism in sepsis and an alternative viewpoint is that some of the hyperlactatemia produced maybe adaptive. This study was conducted to explore the relationship between serum lactate levels, mean arterial blood pressure (MAP), and sympathetic stimulation in patients with sepsis.MethodsRetrospective analysis of prospectively collected clinical data from four community-based hospitals and one academic medical center. 8173 adults were included. Heart rate (HR) was used as a surrogate marker of sympathetic stimulation. HR, MAP, and lactate levels were measured upon presentation.ResultsMAP and HR interacted to affect lactate levels with the highest levels observed in patients with low MAP and high HR (3.6 mmol/L) and the lowest in patients with high MAP and low HR (2.2 mmol/L). The overall mortality rate was 12.4%. Each 10 beats/min increase in HR increased the odds of death 6.0% (95% CI 2.6% to 9.4%), each 1 mmol/L increase in lactate increased the odds of death 20.8% (95% CI 17.4% to 24.2%), whereas each 10 mmHg increase in MAP reduced the odds of death 12.3% (95% CI 9.2% to 15.4%). However, HR did not moderate or mediate the association between lactate and death.ConclusionsIn septic patients, lactate production was associated with increased sympathetic activity (HR ≥ 90) and hypotension (MAP < 65 mmHg) and was a significant predictor of mortality. Because HR, lactate, and MAP were associated with mortality, our data support the present strategy of using these measurements to gauge severity of illness upon presentation. Since HR did not moderate or mediate the association between lactate and death, criticisms alleging that lactate caused by sympathetic stimulation is adaptive (i.e., less harmful) do not appear substantiated.

【 授权许可】

CC BY