Prognostic Value of Arterial Lactate Metabolic Clearance Rate in Moderate and Severe Acute Pancreatitis

Purpose. High lactate levels at hospital admission are significantly associated with poor prognosis in acute pancreatitis patients. Early high lactate clearance is a vital marker for predicting persistent organ failure and mortality in critical illness; however, its value in acute pancreatitis remai...

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Published in:Disease markers 2022-11, Vol.2022, p.1-8
Main Authors: Zeng, Jiji, Wan, Jianhua, He, Wenhua, Zhu, Yong, Zeng, Hao, Liu, Pi, Gong, Min, Liu, Fen, Shao, Qiang, Xia, Liang, Zhu, Yin, Chen, Youxiang, Lu, Nonghua
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Language:English
Subjects:
Abdomen
Biomarkers
Blood
Death
Failure rates
Lactic acid
Length of stay
Medical prognosis
Metabolism
Mortality
Multiple organ dysfunction syndrome
Multivariate analysis
Necrosis
Pancreatitis
Patients
Regression analysis
Sepsis
Statistical analysis
Urea
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cited_by cdi_FETCH-LOGICAL-c425t-5e70867b4c911b67586c96696f346743ed531a3391b0f22d3a515fee2f2e9a23
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container_title Disease markers
container_volume 2022
creator Zeng, Jiji
Wan, Jianhua
He, Wenhua
Zhu, Yong
Zeng, Hao
Liu, Pi
Gong, Min
Liu, Fen
Shao, Qiang
Xia, Liang
Zhu, Yin
Chen, Youxiang
Lu, Nonghua
description Purpose. High lactate levels at hospital admission are significantly associated with poor prognosis in acute pancreatitis patients. Early high lactate clearance is a vital marker for predicting persistent organ failure and mortality in critical illness; however, its value in acute pancreatitis remains unclear. Method. Data were collected from patients who were diagnosed with moderately severe acute pancreatitis and severe acute pancreatitis from January 2017 to December 2020. Initial lactate (within 2 hours after admission) and repeat lactate at 24 hours after admission were measured to determine lactate clearance. Low clearance was defined as a reduction in repeat lactate of less than 30% compared to the first measurement. High clearance was defined as a repeat lactate decrease ≥30% of the first measurement or both first and second lactate levels
doi_str_mv 10.1155/2022/9233199
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High lactate levels at hospital admission are significantly associated with poor prognosis in acute pancreatitis patients. Early high lactate clearance is a vital marker for predicting persistent organ failure and mortality in critical illness; however, its value in acute pancreatitis remains unclear. Method. Data were collected from patients who were diagnosed with moderately severe acute pancreatitis and severe acute pancreatitis from January 2017 to December 2020. Initial lactate (within 2 hours after admission) and repeat lactate at 24 hours after admission were measured to determine lactate clearance. Low clearance was defined as a reduction in repeat lactate of less than 30% compared to the first measurement. High clearance was defined as a repeat lactate decrease ≥30% of the first measurement or both first and second lactate levels &lt;2 mmol/L. Baseline data, laboratory data, mortality rate, persistent organ failure rate, and other outcomes such as the incidence of septic pancreatic necrosis and sepsis and the length of hospital stay and intensive care unit (ICU) stay were compared in the low and high lactate clearance groups. Multivariate logistic regression analyses were used to assess the value of lactate clearance for predicting death. Result. Among 4425 acute pancreatitis patients, 3040 patients were diagnosed with moderate or severe acute pancreatitis, and 1028 patients had initial lactate measured. Finally, 390 patients who had initial and 24-hour repeat lactate data were included in the study. Patients who had elevated initial lactate had poor outcomes, and 51 patients in the initial elevated lactate group died. In the lactate normalization group analysis, 293 patients had 24-hour lactate normalization; compared with patients in the nonnormalization group, they had a lower rate of mortality (12.6% vs. 33%). In the lactate clearance group analysis, 70 (21.9%) patients had a low clearance after 24 hours; compared with patients in the high clearance group, they had a higher rate of developing persistent multiorgan failure (P=0.045), and the incidence of death was higher (15% vs. 28.6%, P=0.007). Multivariate logistic analysis showed that 24-hour lactate clearance (OR: 2.007; 95% CI:1.032-3.903, P=0.04), elevated initial lactate (OR: 2.011; 95% CI:1.023-3.953, P=0.043), blood urea nitrogen (OR: 2.316; 95% CI:1.061-5.056, P=0.035), and white blood count (OR: 1.982; 95% CI:1.026-3.829, P=0.042) were independent predictors of hospital mortality. Conclusion. The 24-hour clearance of lactate is a reliable marker to predict the outcome of moderate and severe acute pancreatitis, and low lactate clearance may indicate that the patient’s condition will worsen, requiring aggressive treatments to improve patient outcomes.</description><identifier>ISSN: 0278-0240</identifier><identifier>EISSN: 1875-8630</identifier><identifier>DOI: 10.1155/2022/9233199</identifier><language>eng</language><publisher>Amsterdam: Hindawi</publisher><subject>Abdomen ; Biomarkers ; Blood ; Death ; Failure rates ; Lactic acid ; Length of stay ; Medical prognosis ; Metabolism ; Mortality ; Multiple organ dysfunction syndrome ; Multivariate analysis ; Necrosis ; Pancreatitis ; Patients ; Regression analysis ; Sepsis ; Statistical analysis ; Urea</subject><ispartof>Disease markers, 2022-11, Vol.2022, p.1-8</ispartof><rights>Copyright © 2022 Jiji Zeng et al.</rights><rights>Copyright © 2022 Jiji Zeng et al. This is an open access article distributed under the Creative Commons Attribution License (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. https://creativecommons.org/licenses/by/4.0</rights><rights>Copyright © 2022 Jiji Zeng et al. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c425t-5e70867b4c911b67586c96696f346743ed531a3391b0f22d3a515fee2f2e9a23</citedby><cites>FETCH-LOGICAL-c425t-5e70867b4c911b67586c96696f346743ed531a3391b0f22d3a515fee2f2e9a23</cites><orcidid>0000-0003-4373-551X ; 0000-0001-7209-9407</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids></links><search><contributor>Maugeri, Andrea</contributor><contributor>Andrea Maugeri</contributor><creatorcontrib>Zeng, Jiji</creatorcontrib><creatorcontrib>Wan, Jianhua</creatorcontrib><creatorcontrib>He, Wenhua</creatorcontrib><creatorcontrib>Zhu, Yong</creatorcontrib><creatorcontrib>Zeng, Hao</creatorcontrib><creatorcontrib>Liu, Pi</creatorcontrib><creatorcontrib>Gong, Min</creatorcontrib><creatorcontrib>Liu, Fen</creatorcontrib><creatorcontrib>Shao, Qiang</creatorcontrib><creatorcontrib>Xia, Liang</creatorcontrib><creatorcontrib>Zhu, Yin</creatorcontrib><creatorcontrib>Chen, Youxiang</creatorcontrib><creatorcontrib>Lu, Nonghua</creatorcontrib><title>Prognostic Value of Arterial Lactate Metabolic Clearance Rate in Moderate and Severe Acute Pancreatitis</title><title>Disease markers</title><description>Purpose. High lactate levels at hospital admission are significantly associated with poor prognosis in acute pancreatitis patients. Early high lactate clearance is a vital marker for predicting persistent organ failure and mortality in critical illness; however, its value in acute pancreatitis remains unclear. Method. Data were collected from patients who were diagnosed with moderately severe acute pancreatitis and severe acute pancreatitis from January 2017 to December 2020. Initial lactate (within 2 hours after admission) and repeat lactate at 24 hours after admission were measured to determine lactate clearance. Low clearance was defined as a reduction in repeat lactate of less than 30% compared to the first measurement. High clearance was defined as a repeat lactate decrease ≥30% of the first measurement or both first and second lactate levels &lt;2 mmol/L. Baseline data, laboratory data, mortality rate, persistent organ failure rate, and other outcomes such as the incidence of septic pancreatic necrosis and sepsis and the length of hospital stay and intensive care unit (ICU) stay were compared in the low and high lactate clearance groups. Multivariate logistic regression analyses were used to assess the value of lactate clearance for predicting death. Result. Among 4425 acute pancreatitis patients, 3040 patients were diagnosed with moderate or severe acute pancreatitis, and 1028 patients had initial lactate measured. Finally, 390 patients who had initial and 24-hour repeat lactate data were included in the study. Patients who had elevated initial lactate had poor outcomes, and 51 patients in the initial elevated lactate group died. In the lactate normalization group analysis, 293 patients had 24-hour lactate normalization; compared with patients in the nonnormalization group, they had a lower rate of mortality (12.6% vs. 33%). In the lactate clearance group analysis, 70 (21.9%) patients had a low clearance after 24 hours; compared with patients in the high clearance group, they had a higher rate of developing persistent multiorgan failure (P=0.045), and the incidence of death was higher (15% vs. 28.6%, P=0.007). Multivariate logistic analysis showed that 24-hour lactate clearance (OR: 2.007; 95% CI:1.032-3.903, P=0.04), elevated initial lactate (OR: 2.011; 95% CI:1.023-3.953, P=0.043), blood urea nitrogen (OR: 2.316; 95% CI:1.061-5.056, P=0.035), and white blood count (OR: 1.982; 95% CI:1.026-3.829, P=0.042) were independent predictors of hospital mortality. Conclusion. The 24-hour clearance of lactate is a reliable marker to predict the outcome of moderate and severe acute pancreatitis, and low lactate clearance may indicate that the patient’s condition will worsen, requiring aggressive treatments to improve patient outcomes.</description><subject>Abdomen</subject><subject>Biomarkers</subject><subject>Blood</subject><subject>Death</subject><subject>Failure rates</subject><subject>Lactic acid</subject><subject>Length of stay</subject><subject>Medical prognosis</subject><subject>Metabolism</subject><subject>Mortality</subject><subject>Multiple organ dysfunction syndrome</subject><subject>Multivariate analysis</subject><subject>Necrosis</subject><subject>Pancreatitis</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Sepsis</subject><subject>Statistical analysis</subject><subject>Urea</subject><issn>0278-0240</issn><issn>1875-8630</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp90c9rFDEUB_AgFlxbb_4BAS-Cjs3PyeQiLEu1hS0tWryGTObNNmU2qUmm0v_eDLsIevCUkPfh5T2-CL2l5BOlUp4zwti5ZpxTrV-gFe2UbLqWk5doRZjqGsIEeYVe5_xACGVa6BXa3aa4CzEX7_APO82A44jXqUDydsJb64otgK-h2D5O1WwmsMkGB_jbUvABX8cB0nK3YcDf4QkS4LWb68NtdQls8cXnM3Qy2inDm-N5iu6-XNxtLpvtzderzXrbOMFkaSQo0rWqF05T2rdKdq3TbavbkYtWCQ6D5NRyrmlPRsYGbiWVIwAbGWjL-Cn6fGj7OPd7GByEkuxkHpPf2_RsovXm70rw92YXn0z9pBOS1Abvjw1S_DlDLmbvs4NpsgHinA1TvBNaCqoqffcPfYhzCnW7RSkt6iK6qo8H5VLMOcH4ZxhKzJKaWVIzx9Qq_3Dg9z4M9pf_v_4NvP2W6A</recordid><startdate>20221109</startdate><enddate>20221109</enddate><creator>Zeng, Jiji</creator><creator>Wan, Jianhua</creator><creator>He, Wenhua</creator><creator>Zhu, Yong</creator><creator>Zeng, Hao</creator><creator>Liu, Pi</creator><creator>Gong, Min</creator><creator>Liu, Fen</creator><creator>Shao, Qiang</creator><creator>Xia, Liang</creator><creator>Zhu, Yin</creator><creator>Chen, Youxiang</creator><creator>Lu, Nonghua</creator><general>Hindawi</general><general>Hindawi Limited</general><scope>RHU</scope><scope>RHW</scope><scope>RHX</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QO</scope><scope>7TK</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4373-551X</orcidid><orcidid>https://orcid.org/0000-0001-7209-9407</orcidid></search><sort><creationdate>20221109</creationdate><title>Prognostic Value of Arterial Lactate Metabolic Clearance Rate in Moderate and Severe Acute Pancreatitis</title><author>Zeng, Jiji ; 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High lactate levels at hospital admission are significantly associated with poor prognosis in acute pancreatitis patients. Early high lactate clearance is a vital marker for predicting persistent organ failure and mortality in critical illness; however, its value in acute pancreatitis remains unclear. Method. Data were collected from patients who were diagnosed with moderately severe acute pancreatitis and severe acute pancreatitis from January 2017 to December 2020. Initial lactate (within 2 hours after admission) and repeat lactate at 24 hours after admission were measured to determine lactate clearance. Low clearance was defined as a reduction in repeat lactate of less than 30% compared to the first measurement. High clearance was defined as a repeat lactate decrease ≥30% of the first measurement or both first and second lactate levels &lt;2 mmol/L. Baseline data, laboratory data, mortality rate, persistent organ failure rate, and other outcomes such as the incidence of septic pancreatic necrosis and sepsis and the length of hospital stay and intensive care unit (ICU) stay were compared in the low and high lactate clearance groups. Multivariate logistic regression analyses were used to assess the value of lactate clearance for predicting death. Result. Among 4425 acute pancreatitis patients, 3040 patients were diagnosed with moderate or severe acute pancreatitis, and 1028 patients had initial lactate measured. Finally, 390 patients who had initial and 24-hour repeat lactate data were included in the study. Patients who had elevated initial lactate had poor outcomes, and 51 patients in the initial elevated lactate group died. In the lactate normalization group analysis, 293 patients had 24-hour lactate normalization; compared with patients in the nonnormalization group, they had a lower rate of mortality (12.6% vs. 33%). In the lactate clearance group analysis, 70 (21.9%) patients had a low clearance after 24 hours; compared with patients in the high clearance group, they had a higher rate of developing persistent multiorgan failure (P=0.045), and the incidence of death was higher (15% vs. 28.6%, P=0.007). Multivariate logistic analysis showed that 24-hour lactate clearance (OR: 2.007; 95% CI:1.032-3.903, P=0.04), elevated initial lactate (OR: 2.011; 95% CI:1.023-3.953, P=0.043), blood urea nitrogen (OR: 2.316; 95% CI:1.061-5.056, P=0.035), and white blood count (OR: 1.982; 95% CI:1.026-3.829, P=0.042) were independent predictors of hospital mortality. Conclusion. The 24-hour clearance of lactate is a reliable marker to predict the outcome of moderate and severe acute pancreatitis, and low lactate clearance may indicate that the patient’s condition will worsen, requiring aggressive treatments to improve patient outcomes.</abstract><cop>Amsterdam</cop><pub>Hindawi</pub><doi>10.1155/2022/9233199</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-4373-551X</orcidid><orcidid>https://orcid.org/0000-0001-7209-9407</orcidid><oa>free_for_read</oa></addata></record>
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subjects Abdomen
Biomarkers
Blood
Death
Failure rates
Lactic acid
Length of stay
Medical prognosis
Metabolism
Mortality
Multiple organ dysfunction syndrome
Multivariate analysis
Necrosis
Pancreatitis
Patients
Regression analysis
Sepsis
Statistical analysis
Urea
title Prognostic Value of Arterial Lactate Metabolic Clearance Rate in Moderate and Severe Acute Pancreatitis
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