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Evaluation of Haas et al for Severe Hyperlactatemia and Percent Lactate Clearance at 12 Hours in a Critically-Ill Patient

Description

Haas et al evaluated critically-ill patients with hyperlactatemia. The change in serum lactate concentration over time is associated with the prognosis. The authors are from University Medical Center Hamburg-Eppendorf.


Patient selection: severe hyperlactatemia (> 10 mmol/L) on admission to the ICU

 

Parameters:

(1) percent change in serum lactate over 12 hours after first measurement > 10 mmol/L

(2) duration of hyperlactatemia in hours

 

percent clearance in 12 hours =

= ((initial serum lactate) - (serum lactate 12 hours later)) / (initial serum lactate) * 100%

Finding

ICU Mortality

hyperlactatemia > 24 hours

96%

hyperlactatemia > 48 hours

100%

12 hour lactate clearance < 32.8%

97%

12 hour lactate clearance > 60%

30%

12 hour lactate clearance < 27% AND septic

> 90%

severe hyperlactatemia with onset > 24 hours after ICU admission

89%

severe hyperlactatemia with onset <= 24 hours ICU admission

70%

 

Interpretation:

• Persistent hyperlactatemia may be an indication of futile ICU care.

 

Performance:

• The area under the ROC curve for 12 hour lactate clearance was 0.91.


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