The association of early combined lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients

Background: The development of renal and liver dysfunction may be accompanied by initially subtle derangements in the gluconeogenetic function. Discrepantly low glucose levels combined with high lactate levels might indicate an impaired Cori cycle. Our objective was to examine the relation between early lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients. Methods: Over a 4-year period (2011 to 2014), all adult patients admitted to our adult 48-bed teaching hospital intensive care unit (ICU) for at least 12 h were retrospectively analyzed. Lactate and glucose were regularly measured with point-of-care analyzers in all ICU patients. Lactate and glucose measurements were collected from 6 h before to 24 h after ICU admission. Patients with fewer than four lactate/glucose measurements were excluded. Patients received insulin according to a computer-guided control algorithm that aimed at a glucose level Results: We analyzed 92,000 blood samples from 9074 patients (63% males) with a median age of 64 years and a hospital mortality of 11%. Both lactate quintiles (2.3 mmol/L) and glucose quintiles (9.0 mmol/L) were related with outcome in univariate analysis (p <0.001). Acute Physiology and Chronic Health Evaluation (APACHE) IV, lactate, and glucose were associated with renal and liver dysfunction in multivariate analysis (p <0.001), with a U-shaped relationship for glucose. The combination of the highest lactate quintile with the lowest glucose quintile was associated with the highest rates of renal dysfunction, liver dysfunction, and mortality (p <0.001) with a significant interaction between lactate and glucose (p Conclusions: Abnormal combined lactate and glucose measurements may provide an early indication of organ dysfunction. In critically ill patients a 'normal' glucose with an elevated lactate should not be considered desirable, as this combination is related with increased mortality

Additional file 2: Figure S5. of The association of early combined lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients

Number of patients per combined lactate and glucose quintiles. Figure S6. Mean APACHE IV score per combined lactate and glucose quintiles. Figure S7. Frequency of diabetes mellitus per combined lactate and glucose quintiles. Figure S8. Frequency of steroid administration per combined lactate and glucose quintiles. Figure S9. Mean insulin dose per combined lactate and glucose quintiles. Figure S10. Mean maximal PT per combined lactate and glucose quintiles. Figure S11. Mean maximal AST per combined lactate and glucose quintiles. Figure S12. Mean maximal ALT per combined lactate and glucose quintiles. Figure S13. Mean maximal AP per combined lactate and glucose quintiles. Figure S14. Mean maximal GGT per combined lactate and glucose quintiles. Figure S15. Glycemic variability in mmol/L during the first 24 h after ICU admission. Figure S16. Predicted mortality per combined lactate and glucose quintiles calculated from only glycometabolic parameters. (PDF 1.12 mb

Additional file 1: Table S4. of The association of early combined lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients

Multivariate logistic regression analyses for the outcome AKI with other covariates. Table S5. Multivariate linear regression analyses for the outcome bilirubin with other covariates. Table S6. Multivariate logistic regression analyses for the outcome mortality with other covariates. Table S7. Linear regression analyses for the continuous outcome variable mean lactate with steroid administration and mean glucose as determinants. (PDF 290 kb