title: The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study.
abstract: OBJECTIVE
  To describe the effect of liver disease (LD) on lactate clearance during early sepsis resuscitation.
  
  
  METHODS
  This is a multicenter randomized clinical trial. An initial lactate >2 mmol/L and subsequent serum lactate measurement within 6 hours were required for inclusion. LD was categorized by two methods: 1) past medical history (PMH) categorized as no LD, mild LD (no Child's score criteria, but PMH of hepatitis B/C), cirrhosis; and 2) measurable liver dysfunction determined by the liver component of the sequential organ failure assessment (L-SOFA) score as no dysfunction (L-SOFA score 0), mild dysfunction (score 1), moderate-severe dysfunction (score 2 to 4). Primary outcome was the rate of lactate normalization.
  
  
  RESULTS
  One hundred eighty-seven patients were included. When categorized by PMH, 169 patients had no LD, 6 mild LD, and 12 cirrhosis. 63/169 (37%) of patients with no LD achieved lactate normalization, compared to 4/6 (67%) with mild LD, and 1/12 (8%) with cirrhosis (P<0.03). Categorized by L-SOFA score, 59/124 (47%) patients with L-SOFA 0 achieved lactate normalization, compared to 6/31 (19%) with L-SOFA 1, and 3/32 (9%) with L-SOFA 2-4 (P<0.01). Relative lactate clearance [(initial lactate-subsequent lactate)/initial lactate] was lower in patients with more advanced LD by PMH (37.7 vs. 40.4 vs. 21.8, P=0.07), and lower with increasing L-SOFA score (42.0 vs. 30.1 vs. 23.4, P=0.01).
  
  
  CONCLUSIONS
  Liver dysfunction was significantly associated with impaired lactate clearance and normalization during the early resuscitation of sepsis.
authors.affiliation: Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Sterling
authors.affiliation: Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Puskarich
authors.affiliation: Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
keywords: Cirrhosis; Lactic acid; Liver diseases; Sepsis; Septic shock