title: Stress hyperlactatemia modifies the relationship between stress hyperglycemia and outcome: a retrospective observational study.
abstract: OBJECTIVE
  To study the effect of stress hyperlactatemia on the association between stress hyperglycemia and mortality.
  
  
  METHODS
  Retrospective cross-sectional observation study.
  
  
  METHODS
  Three ICUs using arterial blood gases with simultaneous glucose and lactate measurements during ICU stay.
  
  
  METHODS
  Cohort of 7,925 consecutive critically ill patients.
  
  
  METHODS
  None.
  
  
  RESULTS
  We analyzed 152,349 simultaneous measurements of glucose and lactate. We performed multivariable analysis to study the association of different metrics of glucose and lactate with hospital mortality. On day 1, first (p = 0.013), highest (p = 0.001), mean (p = 0.019), and time-weighted mean (p = 0.010) glucose levels were associated with increased mortality. A similar, but stronger, association was seen for corresponding lactate metrics (p < 0.0001 for all). However, once glucose and lactate metrics were entered into the multivariable logistic regression model simultaneously, all measures of glycemia ceased to be significantly associated with hospital mortality regardless of the metrics being used (first, highest, mean, time-weighed; p > 0.05 for all), whereas all lactate metrics remained associated with mortality (p < 0.0001 for all). In patients with at least one episode of moderate hypoglycemia (glucose ≤ 3.9 mmol/L), glucose metrics were not associated with mortality when studied separately (p > 0.05 for all), whereas lactate was (p < 0.05 for all), but when incorporated into a model simultaneously, highest glucose on day 1 was associated with mortality (p< 0.05), but not other glucose metrics (p > 0.05), whereas all lactate metrics remained associated with mortality (p < 0.05 for all).
  
  
  CONCLUSIONS
  Stress hyperlactatemia modifies the relationship between hyperglycemia and mortality. There is no independent association between hyperglycemia and mortality once lactate levels are considered.
authors.affiliation: 1Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. 2Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan. 3Intensive Care Unit, Geelong Hospital, Barwon Health, Geelong, Australia. 4Intensive Care Unit, Austin Health, Heidelberg, Australia. 5Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Kirsi-Maija
authors.initials: KM
authors.lastname: Kaukonen
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.forename: Moritoki
authors.initials: M
authors.lastname: Egi
authors.forename: Neil
authors.initials: N
authors.lastname: Orford
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Glassford
authors.forename: Paul E
authors.initials: PE
authors.lastname: Marik
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D018806:APACHE; D000368:Aged; D001784:Blood Gas Analysis; D016638:Critical Illness / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D005947:Glucose / Q000032:analysis*; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D007362:Intensive Care Units; D019344:Lactic Acid / Q000032:analysis*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D013312:Stress, Physiological / Q000502:physiology*; D013997:Time Factors
chemical_list: D019344:Lactic Acid; D005947:Glucose