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

Autor: Nikhil Jagan, Lee E. Morrow, Ryan W. Walters, Robert W. Plambeck, Tej M. Patel, Douglas R. Moore, Mark A. Malesker
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Annals of Intensive Care, Vol 11, Iss 1, Pp 1-9 (2021)
Druh dokumentu: article
ISSN: 2110-5820
DOI: 10.1186/s13613-021-00805-9
Popis: Abstract Background Diametrically 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. Methods Retrospective 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. Results MAP 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. Conclusions In septic patients, lactate production was associated with increased sympathetic activity (HR ≥ 90) and hypotension (MAP
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