Predictive value of early lactate/albumin ratio in the prognosis of sepsis / 中华危重病急救医学

Objective:To investigate the prognostic value of early serum lactate, albumin, and lactate/albumin ratio (L/A) on the 28-day prognosis of adult patients with sepsis.Methods:A retrospective cohort study was conducted among adult patients with sepsis admitted to the First Affiliated Hospital of Xinjiang Medical University from January to December in 2020. Gender, age, comorbidities, lactate within 24 hours of admission, albumin, L/A, interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) and 28-day prognosis were recorded. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of lactate, albumin and L/A for 28-day mortality in patients with sepsis. Subgroup analysis of patients was performed according to the best cut-off value, Kaplan-Meier survival curves were drawn, and the 28-day cumulative survival of patients with sepsis was analyzed.Results:A total of 274 patients with sepsis were included, and 122 patients died at 28 days, with a 28-day mortality of 44.53%. Compared with the survival group, the age, the proportion of pulmonary infection, the proportion of shock, lactate, L/A and IL-6 in the death group were significantly increased, and albumin was significantly decreased [age (years): 65 (51, 79) vs. 57 (48, 73), pulmonary infection: 75.4% vs. 53.3%, shock: 37.7% vs. 15.1%, lactate (mmol/L): 4.76 (2.95, 9.23) vs. 2.21 (1.44, 3.19), L/A: 0.18 (0.10, 0.35) vs. 0.08 (0.05, 0.11), IL-6 (ng/L): 337.00 (97.73, 2 318.50) vs. 55.88 (25.26, 150.65), albumin (g/L): 27.68 (21.02, 33.03) vs. 29.62 (25.25, 34.23), all P < 0.05]. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) of lactate, albumin, and L/A were 0.794 (95% CI was 0.741-0.840), 0.589 (95% CI was 0.528-0.647), 0.807 (95% CI was 0.755-0.852) for predicting 28-day mortality in sepsis patients. The optimal diagnostic cut-off value of lactate was 4.07 mmol/L, the sensitivity was 57.38%, the specificity was 92.76%. The optimal diagnostic cut-off value of albumin was 22.28 g/L, the sensitivity was 31.15%, the specificity was 92.76%. The optimal diagnostic cut-off of L/A was 0.16, the sensitivity was 54.92%, and the specificity was 95.39%. Subgroup analysis showed that the 28-day mortality of sepsis patients in the L/A > 0.16 group was significantly higher than that in the L/A ≤ 0.16 group [90.5% (67/74) vs. 27.5% (55/200), P < 0.001]. The 28-day mortality of sepsis patients in the albumin ≤ 22.28 g/L group was significantly higher than that in the albumin > 22.28 g/L group [77.6% (38/49) vs. 37.3% (84/225), P < 0.001]. The 28-day mortality in the group with lactate > 4.07 mmol/L was significantly higher than that in the group with lactate ≤ 4.07 mmol/L [86.4% (70/81) vs. 26.9% (52/193), P < 0.001]. The three were consistent with the analysis results of Kaplan-Meier survival curve. Conclusion:The early serum lactate, albumin, and L/A were all valuable in predicting the 28-day prognosis of patients with sepsis, and L/A was better than lactate and albumin.

Cord blood and serial lactate levels in predicting short-term outcome in term new-born babies with perinatal asphyxia

Introduction: Birth asphyxia is a leading cause of neonatal deaths across the globe. Clinical examination, Apgar score, pH, EEG/aEEG, Lactate are being used as markers for prediction of outcome. Serum Lactate is a better reflector of metabolic mechanism. We intend to study cord blood lactate and serial lactate levels in term birth asphyxia babies. Aim: To determine correlation between cord blood lactate, serial lactate levels and short term outcome in term new-born babies with perinatal asphyxia. Materials and Methods: It was a prospective, observational study. Thirty term babies with birth asphyxia were selected. Their Cord blood lactate, serum lactate at 6, 12, 24 hours of life were correlated to short term outcomes (NICU stay, shock, Acute kidney injury, mortality). Results: Eighteen babies with moderate asphyxia and 12 with severe asphyxia had mean cord blood lactate of 10.4mmol/L and 13.47mmol/L respectively. There was difference in mean lactate levels at 6, 12, 24 hours of life between the babies who survived and expired; also survivors had significant reduction in mean lactate levels at various time points. Babies with moderate asphyxia had no shock and AKI. Babies with severe asphyxia and shock had mean lactate levels of 12mmol/L in survivors and 13.8mmol/L in who expired. Babies with severe asphyxia and AKI had mean lactate of 14mmol/L in survivors and 14.6mmol/L in who expired. Babies with moderate asphyxia had no mortality. In babies with severe asphyxia, survivors had mean lactate of 12.74mmol/L and 14mmol/L in babies who expired. There was no correlation between the lactate levels and the length of the NICU stay. Conclusion: Serial lactate levels can be used to predictor the short term prognosis in term babies with perinatal asphyxia. There was significant difference in mean lactate levels between the babies who survived and expired. Serial lactate levels showed significant reduction in babies who survived.

Ensayo clínico: efecto del sulfato de magnesio sobre los niveles séricos de lactato en el seno coronario / Clinical trial: effect of magnesium sulfate on serum levels of lactate in the coronary sinus

Resumen: Introducción: Se han propuesto varios métodos para controlar la inflamación y preservar el miocardio durante la circulación extracorpórea (CEC), entre ellos podemos mencionar la administración de electrolitos, tales como el magnesio (Mg2+). Objetivo: Comparar el efecto del uso de sulfato de magnesio (MgSO4) prepinzamiento aórtico (pre-PAo) vs placebo sobre los niveles séricos de lactato en el seno coronario en pacientes sometidos a revascularización miocárdica (RVM) multivaso con CEC. Material y métodos: Se realizó un ensayo clínico controlado en 52 pacientes sometidos a RVM multivaso con CEC, aleatorizados para recibir placebo (grupo I) o MgSO4 (grupo II) pre-PAo, y se tomaron muestras sanguíneas del seno coronario en dos tiempos diferentes: T0: pre-PAo y T1: previo al cierre de tórax, cuantificándose el lactato sérico. Para su análisis, se utilizó t de Student y χ2. Una p < 0.05 fue significativa. La información se procesó en SPSS v-22.0. Resultados: Los niveles séricos de lactato en el seno coronario postpinzamiento aórtico (pos-PAo) fueron menores en el grupo II (2.967 ± 0.86 vs 2.154 ± 1.14) mostrando diferencias significativas (p = 0.006). Conclusión: El uso de MgSO4 pre-PAo disminuye los niveles séricos de lactato en el seno coronario en pacientes sometidos a RVM multivaso con CEC.

Abstract: Introduction: Several methods have been proposed to control inflammation and to preserve the myocardium during cardiopulmonary bypass (CABG), including the administration of electrolytes such as magnesium (Mg2+). Objective: To compare the effect of using magnesium sulfate (MgSO4) or a placebo before aortic clamping (AoC) on the serum levels of lactate in the coronary sinus in patients undergoing myocardial multivessel revascularization (MRV) with CABG. Material and methods: A clinical assay was conducted with 52 patients undergoing MRV multivessel with CEC; the patients were randomized to receive a placebo (group I) or MgSO4 (group II) before AoC, and blood samples were taken from the coronary sinus to quantify serum lactate at two different times: T0: pre-AoC and T1: before closing the chest. Statistical analysis was performed on Student's t-test and χ2. A p < 0.05 was considered statistically significant. The data were processed with SPSS v-22.0. Results: Serum levels of lactate in the coronary sinus post-AoC were lower in group II (2.967 ± 0.86 vs 2.154 ± 1.14), with significant differences (p = 0.006). Conclusion: The use of MgSO4 before AoC reduces serum lactate levels in the coronary sinus in patients undergoing MRV multivessel with CABG.

Medición de los niveles de lactato sérico y frecuencia cardiaca en caninos (Canis lupus familiaris) braquicefálicos, mesocefálicos y dolicocefálicos sometidos a prueba de esfuerzo en trotadora motorizada / Measurement of serum lactate levels and heart rate in canines (Canis lupus familiaris) Brachycephalic, Mesocephalic and Dolichocephalic submitted to a stress test on a motorized treadmill

RESUMEN Se analizaron los niveles de lactato sérico y de frecuencia cardiaca (FC) en 15 perros clinicamente sanos que fueron sometidos a pruebas de esfuerzo en trotadora motorizada, buscando verificar un grado de fatiga muscular frente a una prueba de esfuerzo intenso. Se consideraron pacientes con morfologia craneana de tipo braquicefálico, mesocefálico y dolicocefálico. Las mediciones séricas de lactato fueron conseguidas por medio de un medidor portátil, mientras que las frecuencias cardiacas se obtuvieron a través de un oximetro portátil a los tiempos 0, 10, 20 y 30 minutos, en los diferentes momentos de esfuerzo fisico en la trotadora motorizada, la cual fue adaptada en su inclinación en 15% y a un máximo de velocidad de 10 km/h. Las medias de los niveles séricos entre perros mesocefálicos y dolicocefálicos fueron significativas, a diferencia de los perros braquicefálicos los cuales resultaron no significativos. Las medias de las frecuencias cardiacas no tuvieron diferencia significativa bajo un 95% de confianza.

ABSTRACT Serum lactate and heart rate (HR) levels were analyzed in 15 clinically healthy dogs that were subjected to stress tests on a motorized treadmill, seeking to verify a degree of muscle fatigue compared to an intense exercise test. Patients with brachycephalic, mesocephalic and dolichocephalic type cranial morphology were considered. Serum lactate measurements were procured by means of a portable meter, while heart rates were obtained through a portable oximeter at the times 0, 10, 20, and 30 minutes at different moments of physical effort on the motorized treadmill, which was adapted in its inclination by 15% and at a maximum speed of 10 km/h. Mean serum levels between mesocephalic and dolichocephalic dogs were significant, unlike brachycephalic dogs, which were not significant. The mean heart rates did not have a significant difference under 95% confidence.

Significación del lactato sérico como biomarcador de infección del neonato intervenido quirúrgicamente / Significance of serum lactate as a biomarker of infection of the newborn undergoing surgery

Introducción: El neonato que se interviene quirúrgicamente está expuesto al desarrollo de infecciones. El lactato sérico ha sido recomendado como criterio diagnóstico de sepsis. Objetivo: Determinar la magnitud de asociación del valor del lactato sérico con la sepsis en el neonato intervenido quirúrgicamente. Métodos: Estudio entre 2013 y 2016, en el Hospital Pediátrico Universitario William Soler, en 307 neonatos intervenidos quirúrgicamente. Las variables se agruparon en: clínicas (edad gestacional, peso al nacer, causa de la intervención quirúrgica, localización de la infección) y paraclínicas (microorganismo causal, lactato sérico). Se aplicó la prueba de correlación lineal de Pearson parcial y se estimó odds ratio con el control de la variable infección (sí y no) para identificar la correlación entre los valores de lactato sérico en el preoperatorio y en el posoperatorio. Resultados: De los neonatos 63 tenían bajo peso (20,52 por ciento) y 55 eran pretérminos (17,92 por ciento). En los neonatos infectados 20,83 por ciento fueron operados por afecciones digestivas (n= 35); las infecciones sistémicas alcanzaron 67,74 por ciento (n= 42), ocasionadas en 45,24 por ciento por Cándida sp. La velocidad de cambio de los valores del lactato sérico en los infectados (p= 0,001) significó que por cada unidad en mmol/L que ascendió el lactato preoperatorio, en el posoperatorio se incrementó 0,489 mmol/L y estos cambios fueron debidos en 16,9 por ciento a los valores del lactato preoperatorio. Conclusiones: El lactato sérico está asociado a la infección en los neonatos intervenidos quirúrgicamente y es un biomarcador de sepsis útil en los cuidados intensivos neonatales(AU)

Introduction: The newborn undergoing a surgery is exposed to the development of infections. The serum lactate has been recommended as a diagnostic criterion of sepsis. Objective: To determine the magnitude of association of the value of serum lactate with sepsis in the newborn undergoing a surgery. Methods: Study conducted from 2013 to 2016 in William Soler Pediatric Teaching Hospital, to 307 newborns whom underwent surgery. The variables were grouped in: clinical (gestational age, birth weight, cause of surgical intervention, location of the infection) and paraclinical (causative microorganisms, serum lactate). The partial Pearson's test of linear correlation was applied and it was estimated the odds ratio with the control of the variable infection (yes and no) to identify correlation between serum lactate values in the preoperative and postoperative results. Results: Of the newborns, 63 were under weight (20.52 percent) and 55 were preterm infants (17.92 percent). In the infected newborns, 20.83 percent were operated due to digestive conditions (n= 35); systemic infections reached 67.74 percent (n= 42), caused in 45.24 percent by Candida sp. The rate of change of the values of serum lactate in infected subjects (p= 0.001) meant that for each unit in mmol/L in which increased the preoperative lactate, the postoperative increased 0.489 mmol/L; and these changes were due in a 16.9 percent to the values of preoperative lactate. Conclusions: The serum lactate is associated to the infection in newborns that underwent surgery and is a useful biomarker of sepsis in neonatal intensive care(AU)

Lactate dehydrogenase as surrogate marker of preeclampsia and eclampsia

Background: Hypertensive disorders of pregnancy is a spectrum of disorder which include chronic hypertension that antedates pregnancy and gestational hypertension or pre-eclampsia that is unique to human pregnancy. It is still a poorly understood condition. The clinical course is progressive and characterized by continuous deterioration that is arrested only by termination of pregnancy. Hence the disease must be detected in early stage and managed appropriately for improved maternal and fetal outcome.Methods: The study consists of 173 antenatal patients of gestational age 28 weeks and above. Study population was divided into two groups, Group 1 consists of 50 antenatal women of normotensive nature served as controls and group 2 consists of 123 antenatal women with confirmed hypertension. Venous blood samples were collected used for the estimation of lactate dehydrogenase enzyme.Results: Out of the total 173 patients 104 women delivered by C-section, 67 by normal vaginal delivery and 2 by assisted breech delivery. Among the women who delivered by caesarean 60 (57.69%) had serum LDH less than 600, 18 (17.30%) had serum LDH between 600 and 800 and 26 (25.00%) had LDH above 800. Among the women who delivered vaginally 61 (91.04%) had LDH less than 600, 1 (1.49%) had LDH between 600 and 800 and 5 (7.46%) had LDH above 800. Only 2 women delivered by assisted breech delivery one with LDH between 600 and 800 and another with S. LDH above 800.Conclusions: The study was done in search of a valuable marker for preeclampsia and Eclampsia which would reflect the severity of the disease and would predict the maternal and fetal outcome. Such markers can help in decision making and can influence the current management protocols in order to achieve a better maternal and perinatal outcome.

Serum lactate as a prognostic marker in patients with sepsis: a prospective study

Background: A prospective study to estimate the serum lactate levels and as a prognostic marker in patients with sepsis.Methods: 170 patients admitted with sepsis in B.L.D.E. (Deemed to be University) Shri. B. M. Patil Medical College, Hospital and Research Centre, Vijayapur from October 2014 to June 2016.Results: In this study the mean serum lactate value of first sample in survivors (146 patients) is 3.8±1.2 and non-survivors (24 patients) is 6.2±1.9 with p value<0.001 which is significant. The serum lactate value of the second sample in survivors (146) is 2.7±1.0 and in non survivors (24) is 6.3±1.8 with p value<0.001 which is significant. The mean value of serum lactate 1st sample collected at the time of admission is 4.1±1.6 and the mean value of serum lactate second sample collected at 24 - 48 hours after admission is 3.1±1.6.Conclusions: Lactate level more than 4 mmol/l, patients are at highest risk of mortality and an aggressive resuscitation strategy shall be warranted. Hence serum lactate is considered as an independent and significant prognostic marker in patients with sepsis and evaluates the treatment outcome.

Posterior reversible encephalopathy syndrome in preeclampsia

Background: Posterior reversible encephalopathy is a clinico-radiological syndrome marked by headache, altered mental status, seizures, visual disturbances, and extensive white-matter changes, also known as hyper perfusion encephalopathy, brain capillary leak syndrome, and hypertensive encephalopathy. This syndrome was a possible consequence of several medical conditions but especially in pregnancy it is associated with pre-eclampsia and eclampsia. Objective of this study was to know the incidence and analyze the clinical features, biochemical, and radiological abnormalities in posterior reversible encephalopathy syndrome (PRES) as a complication of preeclampsia.Methods: This was a one-year cross-sectional analytical study conducted at NRI general hospital, Chinakakani, Guntur of patients with the diagnosis of PRES. Data was obtained from medical records and analyzed them in terms of mean for continuous variables and percentages for categorical data.Results: Total no of patients diagnosed as PRES were 16 out of 127 patients of preeclampsia. Among them, 14 presented with eclampsia, and two presented with severe preeclampsia and imminent symptoms of eclampsia. Headache was the most common symptom (100%). PRES occurred at a peak SBP of ≥160 mmHg in 75% cases and peak DBP of ≥110 mmHg in 50% cases. Serum lactate dehydrogenase (LDH) level was ≥600 in 56.25% and serum uric acid level ≥6 in 50% of patients of PRES. The drug of choice was magnesium sulfate.Conclusions: Neuroimaging abnormality is a definitive component in the diagnosis of PRES. These cerebral abnormalities are vital components in the pathogenesis of eclampsia. Considerable number of patients of preeclampsia might develop PRES even without eclampsia, with mild elevation in BP, serum LDH, and serum uric acid levels.

Study of thermo-regulation as a worsening marker of experimental sepsis in an animal model / Estudo da termorregulação como marcador de agravamento do quadro de sepse experimental em modelo animal / Estudio de la termorregulación como marcador asociado al empeoramiento del cuadro de la sepsis experimental en un modelo con animales

Objective: to analyze variations in body temperature and in plasma nitrate and lactate concentrations in rats submitted to the experimental sepsis model. Method: a total of 40 rats divided equally into five groups. The induction of endotoxemia was performed with intravenous administration of lipopolysaccharide, 0.5 mg/Kg, 1.5 mg/Kg, 3.0 mg/Kg, and 10 mg/Kg, respectively. The control group received 0.5 mL of saline solution. The experiment lasted six hours, with evaluations performed at 0 (baseline data), 2nd, 4th, and 6thhours. Results: The animals that received doses up to 3.0 mg/kg showed a significant increase in body temperature compared to the group with 10 mg/kg, which showed a decrease in these values. The increase in plasma nitrate and lactate concentrations in the groups with lipopolysaccharide was significantly higher than in the group that received the saline solution and was correlated with the increase in body temperature. Conclusion: the variations in body temperature observed in this study showed the dose-dependent effect of lipopolysaccharide and were correlated with the increase in the concentrations of nitrate and plasma lactate biomarkers. The implications of this study are the importance of monitoring body temperature, together with the assessment of these pathophysiological markers, which suggest worsening in the prognosis of sepsis.

Objetivo: analisar as variações na temperatura corporal e nas concentrações de nitrato e lactato plasmáticos em ratos submetidos ao modelo de sepse experimental. Método: foram utilizados 40 ratos divididos igualmente em cinco grupos. A indução da endotoxemia foi realizada com administração endovenosa de lipopolissacarídeo, respectivamente 0,5 mg/Kg, 1,5 mg/Kg, 3,0 mg/Kg e 10 mg/Kg. O grupo controle recebeu 0,5 mL de solução salina. O experimento teve duração de seis horas, com avaliações realizadas na 0 (dados basais), 2a, 4a e 6a hora. Resultados: os animais que receberam doses de até 3,0 mg/Kg apresentaram aumento significativo na temperatura corporal em relação ao grupo com 10 mg/Kg, que apresentou diminuição nesses valores. O aumento nas concentrações de nitrato e lactato plasmáticos nos grupos com lipopolissacarídeo foi significativamente superior ao grupo que recebeu salina e esteve correlacionado com o aumento na temperatura corporal. Conclusão: as variações na temperatura corporal observadas neste estudo mostraram efeito dose dependentes de lipopolissacarídeo e estiveram correlacionadas com o aumento nas concentrações dos biomarcadores nitrato e lactato plasmáticos. O estudo traz como implicações, a importância no monitoramento da temperatura corporal, em conjunto com a avaliação destes marcadores fisiopatológicos, os quais sugerem agravamento no prognóstico da sepse.

Objetivo: analizar las variaciones de la temperatura corporal y de las concentraciones de nitrato y lactato en plasma en ratones sometidos a un modelo de sepsis experimental. Método: se utilizaron 40 ratones divididos en cinco grupos iguales. La inducción de la endotoxemia se realizó mediante administración intravenosa de 0,5 mg/Kg, 1,5 mg/Kg, 3,0 mg/Kg y 10 mg/Kg de lipopolisacárido, respectivamente. El grupo de control recibió 0,5 mL de solución salina. El experimento duró seis horas, con evaluaciones realizadas a la hora 0 (datos de referencia) y a la 2a, 4a y 6ahora. Resultados: los animales que recibieron dosis de hasta 3,0 mg/kg presentaron un aumento significativo de la temperatura corporal, en comparación con el grupo al que se le administró 10 mg/kg, que presentó una disminución de dichos valores. En los grupos a los que se les administró lipopolisacárido, el aumento en las concentraciones de nitrato y lactato en plasma fue significativamente mayor que en el grupo al que se le administró la solución salina y estuvo correlacionado con el aumento de la temperatura corporal. Conclusión: las variaciones de la temperatura corporal observadas en este estudio mostraron que los efectos dependieron de la dosis de lipopolisacárido, y estuvieron correlacionadas con el aumento en la concentración de biomarcadores, como el nitrato y lactato en plasma. El estudio reveló la importancia del control de la temperatura corporal, junto con la evaluación de estos marcadores fisiopatológicos, que sugieren un empeoramiento en el pronóstico de la sepsis.

A study on the role of paediatric assessment triangle, clinical scoring and serum lactate in the management of septic shock in children

Background: There is dearth of studies in India on the management of paediatric septic shock. So it is prudent to do a study on paediatric septic shock management. The objective of the study is to determine the correlation between Paediatric Assessment Triangle and serum lactate levels., to determine the role Paediatric Assessment Triangle in predicting mortality in septic shock and to the determine the role of elevated lactate levels in predicting mortality in septic shock.Methods: Descriptive study of 100 children from 31 days to 12 years of age who are admitted with septic shock in a tertiary care hospital are assessed with paediatric assessment triangle and clinical score and serum lactate was tested along with other standard tests and the children are managed as per the standard protocols. Outcome is analysed.Results: In this study, septic shock children with total clinical score >22 are having statistically significant low levels of diastolic blood pressure and low mean arterial pressure. There was a significant difference in median serum lactate levels between the survivors (28.08 mg/dl) and non-survivors (40.92 mg/dl).Conclusions: Paediatric assessment triangle and clinical scoring based on it more than 22 and serum lactate levels of more than 2mmol/L or 18mg/dl predict the mortality.

Study of serum lactate dehydrogenase level as diagnostic and prognostic indicator of megaloblastic anemia

Background: Megaloblastic anaemia is the hematologic manifestation of faulty proliferation of blood cell precursors. The present study was done to facilitate the diagnosis prior to performing any bone marrow aspirate by estimation of the value of serum LDH in the diagnosis of megaloblastic anaemia.Methods: The cases were selected from patients attended the OPD and admitted in Sanjay Gandhi Memorial Hospital & Gandhi Memorial Hospital, Shyam Shah Medical College, Rewa, Madhya Pradesh. Following investigations were then done to classify anaemia and to establish the diagnosis of megaloblastic anaemia like Haemoglobin estimation by cyanmethaemoglobin method, PCV, RBC count and absolute values, general blood picture, reticulocyte count, bone marrow examination and serum LDH estimation before and after treatment.Results: Of the 100 cases, 50 cases (50%) of the cases were microcytic hypochromic anaemia. 15 cases (15%) were normocytic normochromic anaemia; 35 cases (35%) were macrocytic anaemia on the basis of general blood picture and absolute values. The incidence of megaloblastic anaemia in Indian adults was 20%. Maximum number of cases (90%) of the cases had serum LDH level of more than 1000 U/L. Range of serum LDH level was 520 U/L to 4520 U/L. Thus, there was 2 to 20-fold of highest reference value (240 U/L at37 C) rise in serum LDH level in megaloblastic anaemia.Conclusions: Megaloblasatic anaemia is not uncommon in Indian adults and serum LDH levels provide an important means of diagnosis. It is a non-invasive procedure, safe, and does not require any expertise.

Comparison of diagnostic and prognostic value of serum procalcitonin and serum lactate in pediatric sepsis

Background: The clinical manifestations of sepsis are highly variable. The signs of both infection and organ dysfunction may be subtle, and thus the most recent international consensus guidelines provide a long list of warning signs of incipient sepsis. Lactic acid, which is a by-product of anaerobic metabolism, can be used as a marker of tissue hypoperfusion. It is being used widely. Procalcitonin has more recently been studied in children.Methods: Totally 60 Children admitted with Septic Shock in PICU between Ages 3 Months to 12 Years were assessed for Serum Lactate & Serum Procalcitonin levels. Evaluation of the biomarkers was done on individual and combinational basis using receiver operating characteristics curve.Results: Out of 60 children, male were 40, female were 20 children. In stage-1 serum lactate' level was 47.83 (mg/dl) sensitivity is about 35.63 and specificity was 63.82' off p-value <0.065**.In stage -2 serum procalcitonin was 49.62 (mg/dl) sensitivity is about 37.77 and specificity was 69.28' off p-value <0.549**.In stage -3 serum procalcitonin was 52.89 (mg/dl) sensitivity is about 41.63 and specificity was 73.89' off p-value <0.651**Conclusions: Early recognition of risk factors will help in timely appropriate therapy and thereby will help in reducing mortality and morbidity in pediatric septic shock. The results suggest that PCT is valid for auxiliary diagnosis of septic conditions in children and used as an indicator of the severity of patients.

Assessment of serum lactate levels, blood glucose values and blood gas values in sheep, newborn lambs and placenta / Avaliação da concentração de lactato sérico, glicemia e hemogasometria de ovelhas, cordeiros recém-nascidos e placenta

Newborn animals, in the fetal-to-neonatal transition, usually face several challenges in their first 24 hours, including issues with acid-base balance, glycemic levels and oxygenation. Difficulties to overcome such issues have caused several deaths among newborns. Therefore, studies have been carried out in order to evaluate them. The main purpose of this study is to evaluate the correlation between the serum lactate level in the mother, in the placenta and in the newborn. Moreover, the study measured the lactate level, blood glucose level and blood gas level in the first 24 hours. Tests were carried out right after birth, and at 4, 8, 12 and 24 hours after. Lactate levels were quite similar to the placental levels (p=0.991) which, in turn, were significantly different from the mother's (p=0.011). Results showed that, shortly after birth, the production of lactate in the placenta is part of the issue. Along the first 24 hours, the study observed a reduction of the levels of lactate in newborns; the levels were closer to the normal index levels for the species. Regarding the blood gas test results, we observed mild metabolic acidosis at birth; acid-base balance was completely stable at the end of the period.(AU)

Os principais desafios da transição fetal-neonatal são a estabilização do equilíbrio ácido-básico, glicemia e oxigenação ao longo das primeiras 24 horas de vida. Falhas nesse sistema são a maior causa de morte nesse período e os estudos de viabilidade neonatal tem se concentrado nas avaliações destas variáveis. O objetivo do presente estudo foi avaliar a comparação da lactatemia materna, placentária e neonatal ao nascimento e, ainda, observar o comportamento do lactato, glicemia e hemogasometria nas primeiras 24 horas de vida do neonato ovino. Para tanto, as avaliações foram realizadas ao nascimento, 4, 8, 12 e 24 horas após. A lactatemia neonatal se mostrou próxima à placentária (p=0,991) e significativamente diferente da materna (p=0,011), o que sugere uma influência da produção de lactato pela placenta na lactatemia neonatal ao nascimento. Ao longo das 24 horas de vida foi possível observar a depuração de lactato pelo organismo do neonato, aproximando assim dos valores de referência para a espécie. Na hemogasometria foi possível observar discreta acidose metabólica, com normalização já nas primeiras 4 horas e estabilização completa do equilíbrio ácido-básico ao final das 24 horas de vida.(AU)

Correlation between regional tissue perfusion saturation and lactate level during cardiopulmonary bypass / 대한마취과학회지

BACKGROUND: Cardiopulmonary bypass (CPB) can cause systemic hypoperfusion, which remains undetected by routine monitoring of physiological parameters. Noninvasive tissue perfusion monitoring offers a clinical benefit by detecting low systemic perfusion. In this study, we tried to evaluate whether regional tissue perfusion saturation reflects systemic hypoperfusion during CPB. METHODS: This retrospective study included 29 patients with American Society of Anesthesiologists physical status II–III, who required cardiac surgery with CPB. We evaluated the correlations of serum lactate and delivery oxygen with organ perfusion values of peripheral tissue oxygen saturation and cerebral oxygen saturation. Data were recorded at different stages of CPB: T1 (pre-CPB), T2 (cooling), T3 (hypothermia), T4 (rewarming), and T5 (post-CPB). RESULTS: Lactate levels were elevated after CPB and up to weaning (P < 0.05). The levels of peripheral and tissue oxygen saturation decreased after the start of CPB (P < 0.05). Lactate levels were negatively correlated with peripheral tissue oxygen saturation levels at T4 (R = −0.384) and T5 (R = −0.370) and positively correlated with cerebral oxygen saturation at T3 (R = 0.445). Additionally, delivery oxygen was positively correlated with peripheral tissue oxygen saturation at T4 (R = 0.466). CONCLUSIONS: In this study, we demonstrated that peripheral tissue oxygen saturation can be a reliable tool for monitoring systemic hypoperfusion during CPB period. We also believe that peripheral tissue oxygen saturation is a valuable marker for detecting early stages of hypoperfusion during cardiac surgery.

Estimation of serum lactate dehydrogenase in smokeless tobacco consumers.

Statement of Problem: Salivary and serum lactate dehydrogenase (LDH) levels have been correlated with potentially malignant lesions. Salivary LDH levels require special testing and can be expensive. The need for a simple and cost‑effective analysis tool is essential to detect the oral malignant lesions to benefit rural populations. Aim: The aim of this study is to estimate the serum LDH in patients with oral lesions due to the consumption of smokeless tobacco. Materials and Methods: Thirty‑five patients with lesions were selected for this study while twenty patients served as a control. Levels of serum LDH were assessed. Age‑ and sex‑matched controls (n = 10) with no smokeless consumption habit and with the habit but without lesion (n = 10) also had their blood drawn to assess the basal level of LDH. The results were then analyzed through the two‑tailed t‑test and Chi‑square analysis using the SPSS statistics software. Results: The mean LDH value of patients with habit and lesion is 446.8 U/L; the mean LDH value for patients with habit but without the presence of a lesion is 421.2 U/L, and the mean LDH value for patients without a habit or lesion is 269.4 U/L. The patients having the habit of using smokeless tobacco had higher LDH values compared to the other two groups, and it is found to be statistically significant (p < 0.05). Conclusion: Serum LDH values increased in patients with the habit of chewing smokeless tobacco.

Valores de lactato sérico e sua correlação com parâmetros clínicos de cães saudáveis, mensurados durante atendimento ambulatorial veterinário / Serum lactate values and its correlation with clinical parameters evaluated at veterinary ambulatorial exam

A mensuração do lactato sérico é utilizada na rotina médica como marcador prognóstico de pacientes em estado de emergência. Sua interpretação não deve ser feita de forma isolada, mas conjunta aos demais parâmetros clínicos, pois seus valores podem sofrer interferência do estresse metabólico ou ambiental, contenção física e/ ou manipulação dos pacientes. Assim, buscou-se mensurar os valores do lactato sérico e parâmetros clínicos de cães saudáveis, bem como as suas correlações, durante o atendimento clínico ambulatorial veterinário. Para isso, foram avaliados 80 cães, machos ou fêmeas, com idade de um a oito anos, atendidos para revacinação anual polivalente. Foram considerados cães saudáveis os que não apresentaram intercorrências clínicas nos últimos 60 dias e alterações nos exames físicos e nos valores de hemograma e glicemia sérica. Foram mensurados inicialmente o peso corporal, a frequência cardíaca (FC) e respiratória (FR), tempo de preenchimento capilar (TPC), coloração de mucosas, temperatura retal (TR), periférica (TP) e a diferença entre TR e a TP, o Delta T°C. Por último, realizaram-se os exames de hemograma e glicemia sérica, juntamente com a mensuração do lactato sérico, utilizando para isso um lactímetro portátil, por meio da amostra sanguínea obtida da veia cefálica. Além disso, havendo a correlação dos valores do lactato séricos com o peso corporal os cães foram divididos conforme o cálculo do 33° e 66° percentil. Os cães avaliados evidenciaram valores médios de 18,3±12,1 kg de peso corporal e 3,0±1,9 anos de idade; FC de 126,6±29,1bpm, FR de 66±24mpm, TR de 38,9±0,4°C, TP de 31,5±1,0°C, Delta TºC de 7,3±1,0°C e lactato sérico de 3,2±0,4mmol/L; com este último, evidenciando intervalo de confiança a 95% de 3,1-3,3mmol/L e correlação significativa (p<0,05) dos seus valores com o peso corporal (r=0,6) e a frequência cardíaca (r=0,4). Os valores do lactato sérico obtidos foram comparados entre os grupos de cães conforme o peso corporal, evidenciando diferenças significativas (p<0,05) entre eles. Dessa forma, pode se concluir que os valores do lactato sérico em cães hígidos sob atendimento ambulatorial é de 3,2mmol/L, com o intervalo de confiança de 3,1-3,3mmol/L, ressaltando a influência que a FC e o peso corporal podem exercer nos seus valores.(AU)

The measurement of serum lactate is used in the medical routine as a prognosis marker of emergency patients. Its interpretation should not be done disconnectedly from the other clinical parameters once metabolical or environmental stress as well as restraint and/or manipulation of patients can interfere. Thus we tried to measure the levels of serum lactate and clinical parameters of healthy dogs, as their correlation during veterinarian outpatient clinical care. For that we evaluated 80 dogs, males and females, with age ranging from one to eight years, met for polyvalent annual revaccination. We considered to be healthy those dogs that had no clinical events in the last 60 days or alteration in physical exams, blood exam values and serum glycemia. We initially measured body weight, heart rate (HR) and respiratory (RR), capillary refill time, mucosa's coloring, rectal temperature (RT), peripheral temperature (PT) and the difference between RT and PT, Delta T°C. Finally we did the blood exam and the serum glycemia, as well as the serum lactate measurement. For that we used a portable lactimeter, using the blood sample taken from the cephalic vein. Furthermore, when there was correlation between the serum lactate values and the body weight, we divided the dogs according to the calculation of 33 and 66 percentile. Evaluated dogs showed average values of 18.3±12.1 kg of body weight and 3.0±1.9 of age; with HR of 126.6±29.1bpm, RR of 66±24mpm, RT of 38.9±0.4°C, PT of 31.5±1,0°C, Delta T°C of 7.3±1.0°C and serum lactate of 3.2±0.4mmol/L; with the latter showing range of 3.1-3.3mmol/L with 95% of reliability and significant correlation (p<0.05) between its values and the body weight (r=0.6) and the heart rate (r=0.4). The serum lactate values obtained were compared between the dogs' groups according to their body weight, showing distinguished differences between them. Thereby we concluded that the serum lactate values in dogs under outpatient care is 3.2mmol/L, with a trust gap of 3.1-3.3mmol/L, highlighting the influence that HR and body weight can have on its values.(AU)

The relationship between the serum lactate level and in-hospital mortality after decompressive craniectomy in traumatic brain Injury

BACKGROUND: The patients with traumatic brain injury showed ischemia due to increased intracranial pressure. This study evaluated the relationship of pre-anesthetic serum lactate level with in-hospital mortality. METHODS: The archived medical records of 121 patients were retrospectively reviewed. Demographics and preoperative serum lactate level were analyzed. RESULTS: Of the 121 patients, 32 patients expired in the hospital after decompressive craniectomy. Preoperative serum lactate levels were 3.2 +/- 2.2 mmol/L in the survivors and 5.4 +/- 3.0 mmol/L in the dead (P = 0.001), and the receiver operating characteristic curve revealed that a cut off value of 3.60 mmol/L was reasonable for predicting mortality. CONCLUSIONS: Preoperative serum lactate level is highly correlated with in-hospital mortality after decompressive craniectomy in traumatic brain injury.

The Use of Laboratory and Physiological Parameters in Predicting Mortality in Sepsis Induced Hypotension and Septic Shock Patients attending The Emergency Department

Introduction: In this study, we sought to determine whether laboratory and physiological parameters can be useful in predicting mortality in patients with sepsis-induced hypotension and septic shock. Methodology: This prospective cohort study was carried out in the emergency department at an academic medical center. A total of 51 patients met enrollment criteria during the study period and 41 of them were included in the study. Inclusion criteria were patients 18 years old or older, diagnosed to have either sepsis-induced hypotension or septic shock and investigated sepsis marker (blood lactate and leukocytes) measured. Other physiological variables were also measured in this study. The main outcome measure was 30-day mortality. Kaplan-Meier, Log-rank and Cox's methods were used for statistical analysis using SPSS version 12.0.1. Results: 61% were diagnosed to have sepsis-induced hypotension and 39% were diagnosed with septic shock. Twenty two (54%) deaths occurred within the 30 day follow up. The overall mean blood lactate level and leukocyte counts were 3.52 mmol/L (SD=2.29) and 11.37 x 109 (SD=6.38) respectively. A Cox Proportional Hazard Analysis revealed an increase in blood lactate levels in the ED was associated with an increased risk of death (B=0.35, HR=1.45, 95% CI 1.22,1.73, p<0.001). However no significant correlation between the physiological parameters and the 30-day mortality. Patients with septic shock state prior to initial presentation has a lower 30 day survival compared to any other septic conditions. Conclusion: Our results support blood lactate level as a promising risk stratification tool when compared with leukocytes counts and other physiological parameters. The multivariate analysis showed that for every increment of lactate value of 1 mmol/L, the hazards of dying are expected to increase by 1.5 times (p<0.001).

Correlations of the Serum Lactate and the Base Deficit levels to Injury Severity in Trauma Patients

PURPOSE: Although the Injury Severity Score (ISS) has certain predictive limitations and difficulties in calculation, the ISS has been widely used as a predictor of serious injury. The objective of this study was to determine the correlations of the serum lactate and base deficit levels to injury severity and to determine the value of using serum lactate and base deficit measurements as prognostic tools in the emergency department. METHODS: This study was a retrospective analysis of data collected from March 2001 to February 2002, and two hundred seventeen trauma patients who were admitted to the Emergency Department (ED) of Kyungpook National University Hospital during that period were included in this study. Patients who received a transfusion, bicarbonate, or vasopressor or who had no ISS score were excluded from this study. RESULTS: The serum lactate and the base deficit, as well as the ISS, showed a significant value for predicting the seriousness of injury in trauma patients. Because gamma(Pearson's correlation coefficient) between ISS and serum lactate levels is 0.890, it showed strong association. Especially, in multiple injury patients, the serum lactate level had predictive value in revealing hidden injuries that could lead to possible death. Logistic regression showed a strong association between the serum lactate and base deficit levels and mortality rate. CONCLUSION: The serum lactate and the base deficit levels at admission to the ED are useful tools in predicting the outcome in severe trauma patients, and they can be used adjunct to previous injury scoring systems.