• Vincent Sapin, Laurent Nicolet, Bruno Aublet-Cuvelier, Fabienne Sangline, Laurence Roszyk, Bernard Dastugue, Nicole Gazuy, Patrice Deteix, and Bertrand Souweine.
• Department of Biochemistry, Faculty of Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France.
• Clin Chem Lab Med. 2006 Jan 1;44(4):492-6.

BackgroundSplanchnic ischemia plays a major role in the development of organ failure during septic shock. Plasma D-lactate has been proposed as a better marker of splanchnic hypoperfusion than L-lactate. We studied the prognostic ability of plasma D- and L-lactate levels.MethodsA prospective study was performed in an intensive care unit and included patients with septic shock. Two samples for plasma D- and L-lactate determination were collected: the first within 6 h after the patient met the criteria for septic shock (day 1) and the second 24 h later (day 2).ResultsIn univariate analysis, day 1 plasma D- and L-lactate values were associated with 28-day mortality. For plasma D- and L- lactate, the area under the receiver operating characteristic curve was 0.68+/-0.09 and 0.84+/-0.07 on day 1 (p=0.09), and 0.74+/-0.10 and 0.90+/-0.07 on day 2 (p=0.06), respectively. In survivors, D-lactate levels decreased between day 1 and day 2 (p=0.03), but L-lactate did not (p=0.29). In septic shock patients, plasma D- and L-lactate levels reliably discriminate between survivors and non-survivors. The prognostic ability of plasma L-lactate was better than that of plasma D-lactate.ConclusionA rapid decrease in plasma D-lactate during the course of septic shock could indicate reduced 28-day mortality.

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