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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis

Authors: Namkje A. R. Vellinga, E. Christiaan Boerma, Matty Koopmans, Abele Donati, Arnaldo Dubin, Nathan I. Shapiro, Rupert M. Pearse, Peter H. J. van der Voort, Arjen M. Dondorp, Tony Bafi, Michael Fries, Tulin Akarsu-Ayazoglu, Andrius Pranskunas, Steven Hollenberg, Gianmarco Balestra, Mat van Iterson, Farid Sadaka, Gary Minto, Ulku Aypar, F. Javier Hurtado, Giampaolo Martinelli, Didier Payen, Frank van Haren, Anthony Holley, Hernando Gomez, Ravindra L. Mehta, Alejandro H. Rodriguez, Carolina Ruiz, Héctor S. Canales, Jacques Duranteau, Peter E. Spronk, Shaman Jhanji, Sheena Hubble, Marialuisa Chierego, Christian Jung, Daniel Martin, Carlo Sorbara, Jan Bakker, Can Ince, for the microSOAP study group

Published in: Critical Care | Issue 1/2017

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Abstract

Background

Mildly elevated lactate levels (i.e., 1–2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to evaluate the association between relative hyperlactatemia, microcirculatory flow, and outcome.

Methods

This study was a predefined subanalysis of a multicenter international point prevalence study on microcirculatory flow abnormalities, the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Microcirculatory flow abnormalities were assessed with sidestream dark-field imaging. Abnormal microcirculatory flow was defined as a microvascular flow index (MFI) < 2.6. MFI is a semiquantitative score ranging from 0 (no flow) to 3 (continuous flow). Associations between microcirculatory flow abnormalities, single-spot lactate measurements, and outcome were analyzed.

Results

In 338 of 501 patients, lactate levels were available. For this substudy, all 257 patients with lactate levels ≤ 2 mmol/L (median [IQR] 1.04 [0.80–1.40] mmol/L) were included. Crude ICU mortality increased with each lactate quartile. In a multivariable analysis, a lactate level > 1.5 mmol/L was independently associated with a MFI < 2.6 (OR 2.5, 95% CI 1.1–5.7, P = 0.027).

Conclusions

In a heterogeneous ICU population, a single-spot mildly elevated lactate level (even within the reference range) was independently associated with increased mortality and microvascular flow abnormalities. In vivo microscopy of the microcirculation may be helpful in discriminating between flow- and non-flow-related causes of mildly elevated lactate levels.

Trial registration

ClinicalTrials.gov, NCT01179243. Registered on August 3, 2010.
Appendix
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Metadata
Title
Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis
Authors
Namkje A. R. Vellinga
E. Christiaan Boerma
Matty Koopmans
Abele Donati
Arnaldo Dubin
Nathan I. Shapiro
Rupert M. Pearse
Peter H. J. van der Voort
Arjen M. Dondorp
Tony Bafi
Michael Fries
Tulin Akarsu-Ayazoglu
Andrius Pranskunas
Steven Hollenberg
Gianmarco Balestra
Mat van Iterson
Farid Sadaka
Gary Minto
Ulku Aypar
F. Javier Hurtado
Giampaolo Martinelli
Didier Payen
Frank van Haren
Anthony Holley
Hernando Gomez
Ravindra L. Mehta
Alejandro H. Rodriguez
Carolina Ruiz
Héctor S. Canales
Jacques Duranteau
Peter E. Spronk
Shaman Jhanji
Sheena Hubble
Marialuisa Chierego
Christian Jung
Daniel Martin
Carlo Sorbara
Jan Bakker
Can Ince
for the microSOAP study group
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1842-7

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