title: Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock.
abstract: In this prospective, observational study, we measured arterial lactate and pyruvate concentrations within the first four hours of shock and at four hour intervals during the first 24 hours in 26 patients with septic and 13 with cardiogenic shock. We also studied 10 intensive care unit patients with normal lactate levels as controls. Seven patients (18%) died during the first 24 hours of shock, 12 (31%) patients died later in the intensive care unit and 21 (54%) were discharged alive from the intensive care unit. Blood lactate values were higher at shock onset in the non-survivors than in the survivors (P=0.02) and remained significantly elevated throughout the study. The lactate/pyruvate ratio at shock onset was significantly higher in the non-survivors (24 [17 to 34] vs 15 [10 to 19], P=0.01) than in the survivors. All patients with cardiogenic shock had hyperlactataemia at the onset of shock, and 69% had a high lactate/pyruvate ratio. Only 65% of patients with septic shock had hyperlactataemia at the onset of shock and 76% of these also had a high lactate/pyruvate ratio. In conclusion, the lactate/pyruvate ratio confirms that hyperlactataemia is frequently, but not solely, due to hypoxia, especially at the onset of shock.
authors.affiliation: Department of Intensive Care, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Rimachi
authors.forename: F
authors.initials: F
authors.lastname: Bruzzi de Carvahlo
authors.forename: C
authors.initials: C
authors.lastname: Orellano-Jimenez
authors.forename: F
authors.initials: F
authors.lastname: Cotton
authors.forename: J L
authors.initials: JL
authors.lastname: Vincent
authors.forename: D
authors.initials: D
authors.lastname: De Backer
mesh_terms: D018806:APACHE; D000332:Aerobiosis; D000368:Aged; D015415:Biomarkers; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood* / Q000401:mortality; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D019289:Pyruvic Acid / Q000097:blood*; D011786:Quality Control; D012770:Shock, Cardiogenic / Q000097:blood* / Q000401:mortality; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality; D013534:Survival
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D019289:Pyruvic Acid