• Richard Rezar, Behrooz Mamandipoor, Clemens Seelmaier, Christian Jung, Michael Lichtenauer, Uta C Hoppe, Reinhard Kaufmann, Venet Osmani, and Bernhard Wernly.
• Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria. r.rezar@salk.at.
• Wien. Klin. Wochenschr. 2023 Feb 1; 135 (3-4): 808880-88.

AbstractSevere hyperlactatemia (>10mmol/L) or impaired lactate metabolism are known to correlate with increased mortality. The maximum lactate concentration on day 1 of 10,724 septic patients from the eICU Collaborative Research Database was analyzed and patients were divided into three groups based on maximum lactate in the first 24 h (<5mmol/l; ≥5mmol/l & <10mmol/l; ≥10mmol/l). In addition, delta lactate was calculated using the following formula: (maximum lactate day 1 minus maximum lactate day 2) divided by maximum lactate day 1. A multilevel regression analysis was performed, with hospital mortality serving as the primary study end point. Significant differences in hospital mortality were found in patients with hyperlactatemia (lactate ≥10mmol/l: 79%, ≥5mmol/l & <10mmol/l: 43%, <5mmol/l, 13%; p<0.001). The sensitivity of severe hyperlactatemia (≥10mmol/l) for hospital mortality was 17%, the specificity was 99%. In patients with negative delta lactate in the first 24 h, hospital mortality was excessive (92%). In conclusion, mortality in patients with severe hyperlactatemia is very high, especially if it persists for more than 24 h. Severe hyperlactatemia, together with clinical parameters, could therefore provide a basis for setting treatment limits.© 2022. The Author(s).

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