Hyperlactataemia Tied to Poor Mortality in Patients With AKI
Serum lactate levels of more than 4 mmol/L on admission to the intensive care unit (ICU) were associated with an increased rate of 60-day mortality in patients with acute kidney injury (AKI) receiving renal replacement therapy (RRT).
METHODOLOGY:
Researchers conducted a retrospective study over a 4-year period to examine the effect of serum lactate levels during admission to the ICU on mortality in critically ill patients with AKI receiving RRT.
to examine the effect of serum lactate levels during admission to the ICU on mortality in critically ill patients with AKI receiving RRT. They included 154 patients (mean age, 62.8 years; 30.5% women) with stage 3 AKI who received RRT and had data on serum lactate levels at ICU admission; most patients (81.2%) received continuous RRT, and 18.8% of patients received intermittent haemodialysis.
Hyperlactataemia was defined as a serum lactate level above 4 mmol/L on admission to the ICU; 56 patients (36.4%) had acute hyperlactataemia prior to admission to the ICU.
Demographic, comorbidity, and laboratory data were collected from electronic hospital databases and medical records; the severity of illness was evaluated using the Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score, Sepsis-related Organ Failure Assessment (SOFA) score, and Charlson Comorbidity Index (CCI).
TAKEAWAY:
During the 60-day observation period post-ICU admission, 118 patients (76.6%) died, with most deaths (70.1%) occurred during treatment in the ICU; the mean length of ICU stay was 15.7 days.
Patients who died were older ( P < .001), were more likely to have heart failure ( P = .01), and had a higher severity of illness during admission to the ICU (mean CCI, 3.7; P < .001); however, no significant differences in SOFA and APACHE II scores were observed between survivors and non-survivors.
< .001), were more likely to have heart failure ( = .01), and had a higher severity of illness during admission to the ICU (mean CCI, 3.7; < .001); however, no significant differences in SOFA and APACHE II scores were observed between survivors and non-survivors. At 60 days, the survival rate was significantly lower in patients with hyperlactataemia ( P = .032).
= .032). Age (hazard ratio [HR], 1.023; P = .048) and serum lactate levels (HR, 1.065; P = .033) were identified as independent predictors of mortality in this study.
IN PRACTICE:
"The practical recommendation is to measure serum lactate at several points during the ICU stay: on admission, before starting RRT and regularly during and after RRT," the authors wrote.
SOURCE:
This study was led by Robert Ekart, University Medical Centre Maribor, Maribor, Slovenia, and was published online on April 30, 2025, in BMC Nephrology .
LIMITATIONS:
This study was limited by its small sample size and single-centre design. Additionally, the study lacked an analysis of serial measurements of serum lactate levels before and after the start of RRT until discharge, death, or the end of the 60-day observation period.
DISCLOSURES:
This study did not receive any funding. The authors declared having no competing interests.
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