The Role of Lactate-based Serum Tests for Prediction of 30-day Mortality in Hospitalized Cirrhotic Patients with Acute Decompensation: A Prospective Cohort Study

Nattaporn  Kongphakdee; Phubordee  Bongkotvirawan; Sith Siramolpiwat

doi:10.33192/smj.v76i4.268030

Authors

Nattaporn Kongphakdee Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
Phubordee Bongkotvirawan Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
Sith Siramolpiwat Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand / Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand

DOI:

https://doi.org/10.33192/smj.v76i4.268030

Keywords:

Cirrhosis, Lactate, Liver decompensation

Abstract

Objective: Cirrhotic patients with acute decompensation are associated with high short-term mortality. The prognostic performance of venous lactate (VLAC) for mortality prediction in these patients has not been well established. This study aimed to evaluate the role of several lactate-based serum tests for prediction of 30-day mortality in these patients.

Materials and Methods: Cirrhotic patients with acute decompensation were prospectively enrolled. VLAC on admission and at 6, 12, and 24 hours were determined. Lactate clearance (LAC-Cl), MELD-lactate, and MELD-lactate clearance (MELD-ΔLA) at each timepoint were calculated and compared between 30-days survivors and non-survivors.

Results: 74 patients were included (age 69±13 years, 66.2% male, MELD 18.3±7). The main indications for admission were infection (67.6%) and gastrointestinal bleeding (18.9%). The 30-day mortality rate was 29.7%. Initial VLAC was significantly higher in non-survivors (9.7±8 vs. 3.61±1.79 mmol/L, P<0.001). In addition, VLAC at 6, 12, 24 hours, MELD-Lactate and MELD-ΔLA scores were significantly higher in non-survivors. Based on ROC analysis, the VLAC, MELD-Lactate, and MELD-ΔLA at 6 hours were reliable predictors of 30-day mortality (AUROC 0.79, 0.86, and 0.86, respectively). However, compared to MELD score (AUROC 0.81), no significant difference was found.

Conclusion: In hospitalized cirrhotic patient with acute decompensation, VLAC, MELD-Lactate and MELD-ΔLA at 6 hours are simple, and reliable predictors for 30-day mortality.

References

Asrani SK, Hall L, Hagan M, Sharma S, Yeramaneni S, Trotter J, et al. Trends in Chronic Liver Disease-Related Hospitalizations: A Population-Based Study. Am J Gastroenterol. 2019;114(1):98-106.

Desai AP, Mohan P, Nokes B, Sheth D, Knapp S, Boustani M, et al. Increasing Economic Burden in Hospitalized Patients With Cirrhosis: Analysis of a National Database. Clin Transl Gastroenterol. 2019;10(7):e00062.

Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol. 2005;42 Suppl(1):S100-7.

Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013;88(10):1127-40.

Sun DQ, Zheng CF, Lu FB, Van Poucke S, Chen XM, Chen YP, et al. Serum lactate level accurately predicts mortality in critically ill patients with cirrhosis with acute kidney injury. Eur J Gastroenterol Hepatol. 2018;30(11):1361-7.

Jeppesen JB, Mortensen C, Bendtsen F, Moller S. Lactate metabolism in chronic liver disease. Scand J Clin Lab Invest. 2013;73(4):293-9.

Drolz A, Horvatits T, Rutter K, Landahl F, Roedl K, Meersseman P, et al. Lactate Improves Prediction of Short-Term Mortality in Critically Ill Patients With Cirrhosis: A Multinational Study. Hepatology. 2019;69(1):258-69.

Li X, Gong M, Fu S, Zhang J, Wu S. Establishment of MELD-lactate clearance scoring system in predicting death risk of critically ill cirrhotic patients. BMC Gastroenterol. 2022;22(1):280.

Brown C, Aksan N, Muir AJ. MELD-Na Accurately Predicts 6-Month Mortality in Patients With Decompensated Cirrhosis: Potential Trigger for Hospice Referral. J Clin Gastroenterol. 2022;56(10):902-7.

Sarmast N, Ogola GO, Kouznetsova M, Leise MD, Bahirwani R, Maiwall R, et al. Model for End-Stage Liver Disease-Lactate and Prediction of Inpatient Mortality in Patients With Chronic Liver Disease. Hepatology. 2020;72(5):1747-57.

Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486-552.

Vanni S, Viviani G, Baioni M, Pepe G, Nazerian P, Socci F, et al. Prognostic value of plasma lactate levels among patients with acute pulmonary embolism: the thrombo-embolism lactate outcome study. Ann Emerg Med. 2013;61(3):330-8.

Noval-Padillo JA, Serra-Gomez C, Gomez-Sosa L, Hinojosa-Perez R, Huici-Moreno MJ, Adsuar A, et al. Changes of lactate levels during cardiopulmonary bypass in patients undergoing cardiac transplantation: possible early marker of morbidity and mortality. Transplant Proc. 2011;43(6):2249-50.

Regnier MA, Raux M, Le Manach Y, Asencio Y, Gaillard J, Devilliers C, et al. Prognostic significance of blood lactate and lactate clearance in trauma patients. Anesthesiology. 2012;117(6):1276-88.

Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis*. Crit Care Med. 2014;42(9):2118-25.

De Jonghe B, Cheval C, Misset B, Timsit JF, Garrouste M, Montuclard L, et al. Relationship between blood lactate and early hepatic dysfunction in acute circulatory failure. J Crit Care. 1999;14(1):7-11.

Cardoso FS, Abraldes JG, Sy E, Ronco JJ, Bagulho L, McPhail MJ, et al. Lactate and number of organ failures predict intensive care unit mortality in patients with acute-on-chronic liver failure. Liver Int. 2019;39(7):1271-80.

Ha TS, Shin TG, Jo IJ, Hwang SY, Chung CR, Suh GY, et al. Lactate clearance and mortality in septic patients with hepatic dysfunction. Am J Emerg Med. 2016;34(6):1011-5.

Ko BS, Kim WY, Ryoo SM, Ahn S, Sohn CH, Seo DW, et al. Predicting the Occurrence of Hypotension in Stable Patients With Nonvariceal Upper Gastrointestinal Bleeding: Point-of-Care Lactate Testing. Crit Care Med. 2015;43(11):2409-15.

Wada T, Hagiwara A, Uemura T, Yahagi N, Kimura A. Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study. Intern Emerg Med. 2016;11(5):737-43.

Shah A, Chisolm-Straker M, Alexander A, Rattu M, Dikdan S, Manini AF. Prognostic use of lactate to predict inpatient mortality in acute gastrointestinal hemorrhage. Am J Emerg Med. 2014;32(7):752-5.

Mahmud N, Asrani SK, Kaplan DE, Ogola GO, Taddei TH, Kamath PS, et al. The Predictive Role of Model for End-Stage Liver Disease-Lactate and Lactate Clearance for In-Hospital Mortality Among a National Cirrhosis Cohort. Liver Transpl. 2021;27(2):177-89.