Lactate/Pyruvate Ratio As an Early Predictor of Mortality in Patients with Sepsis: A Cohort Study

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Sep 28

PMID 39337084

Authors

Olga G Cantu-Rodriguez

Jose A Hawing-Zarate

Edgar G Dorsey-Trevino

David Hernandez-Barajas

Leonel E Villalobos-Gutierrez

Jose Carlos Jaime-Perez

Consuelo Mancias-Guerra

Oscar Gonzalez-Llano

Graciela A Gonzalez-Cantu

David Gomez-Almaguer

Cesar H Gutierrez-Aguirre

Affiliations

Soon will be listed here.

Abstract

: The lactate/pyruvate (LP) ratio has been studied as an alternative to serum lactate to determine clinical prognosis. Despite its clinical utility, there is a paucity of evidence evaluating the role of the L/P ratio in patients with sepsis. : We assessed the clinical utility of the L/P ratio in patients with sepsis. The L/P ratio was measured at baseline, 4 and 8 h after admission. Our primary outcome was to determine the prognostic utility of the L/P ratio on the 15-day mortality risk. Our secondary outcomes were to compare the L/P ratio across time and its prognostic utility against standard risk calculators such as APACHE-II and SOFA scores. : We had a total of 80 patients, with 18 (22.5%) survivors and 62 (77.5%) non-survivors. While we found that patients having higher L/P ratios at 8 h had an increased 30-mortality risk (OR 1.08, 95% CI 1.02-1.18), the model's performance showed no difference when compared to other measurements of the L/P ratio that showed no association with mortality (-value: 0.45). For our secondary outcome, we found that the APACHE-II and SOFA scores have better performance and predictability than the L/P ratio (AUC 0.83 and AUC 0.80, respectively), but showed no association with mortality (OR 1.07, 95% CI 1.01-1.17 and OR 1.08, 95% CI 1.02-1.18). : Based on our findings, the L/P ratio appears to function more effectively as an early predictor of mortality when used as an adjuvant biomarker with other clinical parameters.

References

Levy B, Sadoune L, Gelot A, Bollaert P, NABET P, LARCAN A . Evolution of lactate/pyruvate and arterial ketone body ratios in the early course of catecholamine-treated septic shock. Crit Care Med. 2000; 28(1):114-9. DOI: 10.1097/00003246-200001000-00019. View

Feldman A, Sokol R, Hardison R, Alonso E, Squires R, Narkewicz M . Lactate and Lactate: Pyruvate Ratio in the Diagnosis and Outcomes of Pediatric Acute Liver Failure. J Pediatr. 2017; 182:217-222.e3. PMC: 5328928. DOI: 10.1016/j.jpeds.2016.12.031. View

Dugas M, Proulx F, de Jaeger A, Lacroix J, Lambert M . Markers of tissue hypoperfusion in pediatric septic shock. Intensive Care Med. 2000; 26(1):75-83. PMC: 7095440. DOI: 10.1007/s001340050015. View

Kim J, Kim Y, Kim W . Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study. Crit Care. 2021; 25(1):11. PMC: 7787242. DOI: 10.1186/s13054-020-03421-4. View

Zeng Z, Huang Q, Mao L, Wu J, An S, Chen Z . The Pyruvate Dehydrogenase Complex in Sepsis: Metabolic Regulation and Targeted Therapy. Front Nutr. 2021; 8:783164. PMC: 8712327. DOI: 10.3389/fnut.2021.783164. View

Vary T, Siegel J, Nakatani T, Sato T, Aoyama H . Effect of sepsis on activity of pyruvate dehydrogenase complex in skeletal muscle and liver. Am J Physiol. 1986; 250(6 Pt 1):E634-40. DOI: 10.1152/ajpendo.1986.250.6.E634. View

Andersen L, Mackenhauer J, Roberts J, Berg K, Cocchi M, Donnino M . Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013; 88(10):1127-40. PMC: 3975915. DOI: 10.1016/j.mayocp.2013.06.012. View

Zhang F, Wang H, Liu L, Su T, Ji B . Machine learning model for the prediction of gram-positive and gram-negative bacterial bloodstream infection based on routine laboratory parameters. BMC Infect Dis. 2023; 23(1):675. PMC: 10566101. DOI: 10.1186/s12879-023-08602-4. View

Rimachi R, Bruzzi de Carvahlo F, Orellano-Jimenez C, Cotton F, Vincent J, De Backer D . Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock. Anaesth Intensive Care. 2012; 40(3):427-32. DOI: 10.1177/0310057X1204000307. View

10.

Kushimoto S, Akaishi S, Sato T, Nomura R, Fujita M, Kudo D . Lactate, a useful marker for disease mortality and severity but an unreliable marker of tissue hypoxia/hypoperfusion in critically ill patients. Acute Med Surg. 2017; 3(4):293-297. PMC: 5667335. DOI: 10.1002/ams2.207. View

11.

Abe R, Oda S, Sadahiro T, Nakamura M, Hirayama Y, Tateishi Y . Gram-negative bacteremia induces greater magnitude of inflammatory response than Gram-positive bacteremia. Crit Care. 2010; 14(2):R27. PMC: 2887127. DOI: 10.1186/cc8898. View

12.

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370(9596):1453-7. DOI: 10.1016/S0140-6736(07)61602-X. View

13.

Lambden S, Laterre P, Levy M, Francois B . The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care. 2019; 23(1):374. PMC: 6880479. DOI: 10.1186/s13054-019-2663-7. View

14.

Levraut J, Ciebiera J, Chave S, Rabary O, Jambou P, Carles M . Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction. Am J Respir Crit Care Med. 1998; 157(4 Pt 1):1021-6. DOI: 10.1164/ajrccm.157.4.9705037. View

15.

Gore D, Jahoor F, Hibbert J, DeMaria E . Lactic acidosis during sepsis is related to increased pyruvate production, not deficits in tissue oxygen availability. Ann Surg. 1996; 224(1):97-102. PMC: 1235253. DOI: 10.1097/00000658-199607000-00015. View

16.

Vorwerk C, Loryman B, Coats T, Stephenson J, Gray L, Reddy G . Prediction of mortality in adult emergency department patients with sepsis. Emerg Med J. 2009; 26(4):254-8. DOI: 10.1136/emj.2007.053298. View

17.

Knaus W, Draper E, Wagner D, Zimmerman J . APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13(10):818-29. View

18.

Nikitas N, Kopterides P, Ilias I, Theodorakopoulou M, Vassiliadi D, Armaganidis A . Elevated adipose tissue lactate to pyruvate (L/P) ratio predicts poor outcome in critically ill patients with septic shock: a microdialysis study. Minerva Anestesiol. 2013; 79(11):1229-37. View

19.

Suistomaa M, Ruokonen E, Kari A, Takala J . Time-pattern of lactate and lactate to pyruvate ratio in the first 24 hours of intensive care emergency admissions. Shock. 2000; 14(1):8-12. DOI: 10.1097/00024382-200014010-00002. View

20.

Shapiro N, Howell M, Talmor D, Nathanson L, Lisbon A, Wolfe R . Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005; 45(5):524-8. DOI: 10.1016/j.annemergmed.2004.12.006. View