Relationship between blood lactate and early hepatic dysfunction in acute circulatory failure.
OBJECTIVE
The purpose of this study was to assess the influence of early hepatic dysfunction on lactate level in patients with acute circulatory failure in a retrospective study.


METHODS
Blood lactate was compared between patients in acute circulatory failure (systolic blood pressure < or = 80 mm Hg despite fluid challenge) with or without early hepatic dysfunction (bilirubin > 60 micromol/L or SGOT > 100 IU/L during the first 48 hours). Univariate and multivariate analysis were performed to assess the effects of early hepatic dysfunction and other clinical and biological data on serum lactate levels in patients with acute circulatory failure.


RESULTS
The study included 92 patients, mean age 64+/-15 years, mean simplified acute physiology score (SAPS) 18.4+/-4.1. Early hepatic dysfunction was identified in 29 patients (32%). Mean initial blood lactate was 5.54+/-4.78 mmol/L. Overall intensive care unit mortality was 67.3%. Although patients with and without hepatic dysfunction showed no significant difference in terms of mean SAPS, mean lowest systolic blood pressure, and mortality, serum lactate was higher in the group with hepatic dysfunction than in the group without hepatic dysfunction (8.24+/-6.49 mmol/L v4.29+/-3.09 mmol/L, P < .001). Factors independently associated with serum lactate were the existence of early hepatic dysfunction (P < .01), a nondistributive type of shock (P < .05), and the mean initial amount of epinephrine (P < .05).


CONCLUSIONS
This study suggests that early hepatic dysfunction plays an important role in serum lactate elevation in acute circulatory failure.
De Jonghe
B
B
Service de Reanimation Polyvalente, Fondation-Hopital Saint-Joseph, Paris, France.
Cheval
C
C
Misset
B
B
Timsit
J F
JF
Garrouste
M
M
Montuclard
L
L
Carlet
J
J
D000368:Aged; D001663:Bilirubin / Q000097:blood; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008107:Liver Diseases / Q000097:blood*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012769:Shock / Q000150:complications*
D019344:Lactic Acid; D001663:Bilirubin