Prognostic value of hyperlactatemia and lactate clearance in septic patients with hematological malignancies

• Published in: Annals of hematology Vol. 103; no. 10; pp. 4239 - 4245
• Main Authors: Inci, Kamil, Aygencel, Gülbin, Gökçe, Onur, Türkoğlu, Melda, Aydın Kaynar, Lale, Can, Ferda, Yeğin, Zeynep Arzu, Özkurt, Zübeyde Nur, Yağcı, Abdullah Münci
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2024; Springer Nature B.V
• Subjects: Adult; Aged; Female; Hematologic Neoplasms - blood; Hematologic Neoplasms - complications; Hematologic Neoplasms - mortality; Hematology; Hospital Mortality; Humans; Hyperlactatemia - blood; Hyperlactatemia - diagnosis; Hyperlactatemia - etiology; Intensive care; Intensive Care Units; Lactic Acid - blood; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Oncology; Prognosis; Retrospective Studies; Sepsis; Sepsis - blood; Sepsis - complications; Sepsis - diagnosis; Sepsis - mortality; Hyperlactatemia; Intensive care unit; Hematological malignancies; Lactate clearance
• ISSN: 0939-5555; 1432-0584; 1432-0584
• DOI: 10.1007/s00277-024-05977-5

Background
The coexistence of sepsis and hematological malignancies increases patient vulnerability, revealing the need for precise prognostic markers. This study explores the prognostic significance of lactate levels and clearance in septic patients with hematological malignancies.
Materials and methods
A retrospective cohort study from January 2016 to December 2019 in a tertiary hematological intensive care unit (ICU) included 167 adults with hematological malignancies and sepsis. The relationship between lactate levels, hyperlactatemia, lactate clearance, and ICU outcomes was investigated. ICU survivors and non-survivors were compared to identify the factors affecting ICU mortality.
Results
Patients were primarily with lymphoma and acute leukemia (66%) and had frequent hyperlactatemia (64%) on ICU admission. ICU non-survivors demonstrated higher lactate levels and hyperlactatemia frequency at various time points (0, 6, and 12 h) than survivors. Lactate clearance and liver function tests did not differ significantly between the two groups. Invasive mechanical ventilation [OR (95% confidence interval-CI): 20.4 (2.4–79.8),
p
 < 0.01], requirement of vasopressors [OR (95% CI): 5.6 (1.3–24.5),
p
 < 0.01], lactate level at the 6th hour [OR (95% CI): 1.51 (1.1–2.07),
p
 = 0.01], and APACHE II score (OR (95% CI): 1.16 (1.01–1.34),
p
 = 0.05) were independent risk factors for ICU mortality. The Area Under the Curve for APACHE II score and lactate level at the 6th hour were 0.774 (95% CI: 0.682–0.866) and 0.703 (95% CI: 0.602–0.804), respectively.
Conclusion
While elevated lactate levels correlate with mortality rate and lactate level at the 6th hour is an independent risk factor for mortality, the absence of a significant difference in lactate clearance challenges traditional assumptions. These results question the commonly accepted perspective regarding lactate dynamics in sepsis among individuals with hematological malignancies.
Oral Presentation
İnci K, et al. “Hyperlactatemia, lactate clearance and outcome in critically ill patients with hematological malignancies,” 22nd ınternational intensive care symposium, 2019.