Pedro Freire Jorge et al. – This study was conducted to determine the relation between early lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients. The results demonstrated that abnormal combined measurements of lactate and glucose may provide an early indication of organ dysfunction. Also, a “normal” glucose with an elevated lactate should not be considered desirable, as this combination was related with increased mortality in critically ill patients.

Methods

• This is a retrospective study of 9074 adult patients (median age: 64 years) who were in the intensive care unit (ICU) for at least 12 hours.
• Lactate and glucose levels were regularly measured and collected from 6 hours before to 24 hours after ICU admission in all patients.
• The patients received insulin based on a guided algorithm aimed at maintaining glucose level at <8.0 mmol/L.
• Renal dysfunction and liver dysfunction were identified based on the development of acute kidney injury within 7 days and the maximal bilirubin in the 7–day period following ICU admission, respectively.
• In addition, the mean lactate and mean glucose classified into quintiles and univariate and multivariate analyses were found to be related with renal and liver dysfunction and hospital mortality.

Results

• As per univariate analysis, lactate quintiles (≤1.0; 1.0–1.3; 1.3–1.7; 1.7–2.3; >2.3 mmol/L) and glucose quintiles (≤7.0; 7.0–7.6; 7.6–8.2; 8.2–9.0; >9.0 mmol/L) were found to be related with the outcome.
• Multivariate analysis demonstrated that Acute Physiology and Chronic Health Evaluation (APACHE) IV, lactate, and glucose were significantly associated with renal and liver dysfunction, with a U–shaped relationship for glucose.
• The results demonstrated that the highest rates of renal dysfunction, liver dysfunction, and mortality were significantly associated with the combination of the highest lactate quintile with the lowest glucose quintile, with a significant interaction between lactate and glucose.