title: Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill.
abstract: BACKGROUND
  Hyperlactatemia is frequent in critically ill patients and is often used as a marker of adverse outcome. However, studies to date have focused on selected intensive care unit (ICU) populations. We sought to determine the occurrence and relation of hyperlactatemia with ICU mortality in all patients admitted to four ICUs in a large regional critical care system.
  
  
  METHODS
  All adults ([greater than or equal to] 18 years) admitted to ICUs in the Calgary Health Region (population 1.2 million) during 2003 to 2006 were included retrospectively. Lactate determinations were at the discretion of the attending service and hyperlactatemia was defined by a lactate level > 2 mmol/L.
  
  
  RESULTS
  A total of 13,932 ICU admissions occurred among 11,581 patients. The median age was 63 years (37% female), the mean APACHE II score was 25 +/- 9 (n = 13,922). At presentation (within first day of admission), 12,246 patients had at least one lactate determination and the median peak lactate was 1.8 (IQR 1.2 to 2.9) mmol/L. The cumulative incidence of at least one documented episode of hyperlactatemia was 5578/13,932 (40%); 5058 (36%) patients had hyperlactatemia at presentation, and a further 520 (4%) developed hyperlactatemia subsequently. The incidence of hyperlactatemia varied significantly by major admitting diagnostic category (P < 0.001) and was highest among neuro/trauma patients 1053/2328 (45%), followed by medical 2047/4935 (41%), other surgical 900/2274 (40%), and cardiac surgical 1578/4395 (36%). Among a cohort of 9107 first admissions with ICU stay of at least one day, both hyperlactatemia at presentation (712/3634 (20%) vs. 289/5473 (5%); P < 0.001) and its later development (101/379 (27%) vs. 188/5094 (4%); P < 0.001) were associated with significantly increased case fatality rates as compared with patients without elevated lactate. After controlling for confounding effects in multivariable logistic regression analysis, hyperlactatemia was an independent risk factor for death.
  
  
  CONCLUSIONS
  Hyperlactatemia is common among the critically ill and predicts risk for death.
authors.affiliation: Department of Critical Care Medicine, University of Calgary, Calgary, Alberta T2N 2T9, Canada. houman.khosravani@gmail.com
authors.forename: Houman
authors.initials: H
authors.lastname: Khosravani
authors.forename: Reza
authors.initials: R
authors.lastname: Shahpori
authors.forename: H Thomas
authors.initials: HT
authors.lastname: Stelfox
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Laupland
mesh_terms: D000137:Acid-Base Imbalance / Q000453:epidemiology* / Q000401:mortality; D000416:Alberta / Q000453:epidemiology; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D019344:Lactic Acid / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies
chemical_list: D019344:Lactic Acid