title: Determining the clinical value of lactate in surgical patients on the intensive care unit.
abstract: BACKGROUND
  The purpose of this study is first to assess the clinical value of lactate concentrations by comparison with clinical scoring systems, and second to determine the value of lactate levels in clinical decisions as ordering diagnostic and therapeutic (re)interventions in the population of critically ill surgical patients on the intensive care unit (ICU).
  
  
  METHODS
  From April 2010 to June 2011, the L-lactate concentrations, Sequential Organ Failure Assessment (SOFA) score and Acute Physiological and Chronic Health Evaluation II (APACHE II) score were prospectively collected in surgical patients (n = 174) admitted into the ICU. The L-Lactate and scoring systems were related to events defined as performing computed tomography-scans, laparotomy, ultrasonography, and flexible endoscopy. Furthermore, all surgical complications were also registered.
  
  
  RESULTS
  For SOFA scores above four points, mean lactate concentrations increased 4.5% for each point increase in SOFA score (P < 0.0005). In APACHE II scores above 16 points, mean lactate concentrations increased 2.9% for each point increase in APACHE II score (P < 0.0005). Each 10% increase in lactate concentration showed a 3.3% higher odds for a first event (OR 1.033; P = 0.26). Lactate levels did not correspond with more complications (OR 0.968; P = 0.52).
  
  
  CONCLUSIONS
  There is a significant positive relationship between lactate concentrations, high SOFA scores, and APACHE II scores. However, the important outcome is that lactate seems to be a poor predictor for surgical complications in the critically ill surgical patient in the ICU.
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands. zienalove@hotmail.com
authors.forename: Zainna C
authors.initials: ZC
authors.lastname: Meyer
authors.forename: Jennifer M J
authors.initials: JM
authors.lastname: Schreinemakers
authors.forename: Paul G H
authors.initials: PG
authors.lastname: Mulder
authors.forename: Ruud A L
authors.initials: RA
authors.lastname: de Waal
authors.forename: Antonius A M
authors.initials: AA
authors.lastname: Ermens
authors.forename: Lijckle
authors.initials: L
authors.lastname: van der Laan
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007773:Lactates / Q000097:blood*; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D007773:Lactates
keywords: Complication(s); Intensive care unit; Lactate; Surgical patient