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

ABSTRACT: Lactate clearance (?24Lac) was reported to be inversely associated with mortality in critically ill patients. The aim of our study was to assess the value of ?24Lac 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 ?24Lac. In the fully adjusted model, the relationship between the risk of death and ?24Lac 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 ?24Lac per 10% increase). Similar results were found in patients with ACLF. We developed a ?24Lac-adjusted score (LiFe-?24Lac), 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-?24Lac score is a practical tool for stratifying the risk of death.

SUBMITTER: Gao F 

PROVIDER: S-EPMC6660055 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature