Hyperlactatemia is associated with increased risks of long-term mortality and major adverse cardiovascular events in sepsis survivors

• Published in: Infectious diseases (London, England) Vol. 55; no. 8; pp. 576 - 584
• Main Authors: Ou, Shu-Yu, Lee, Yi-Jung, Chou, Yu-Mei, Sun, Gwo-Ching, Chia, Yuan-Yi
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03.08.2023
• Subjects: Brain Ischemia - complications; End-stage renal disease; Humans; hyperlactatemia; Hyperlactatemia - complications; Hyperlactatemia - epidemiology; Ischemic Stroke - complications; Kidney Failure, Chronic - complications; Lactic Acid; major adverse cardiac events; mortality; Myocardial Infarction - complications; sepsis; Sepsis - complications; Sepsis - epidemiology; sepsis survivor; Stroke - complications; Survivors; major adverse cardiac events; mortality; End-stage renal disease; hyperlactatemia; sepsis survivor; sepsis
• DOI: 10.1080/23744235.2023.2223273
• ISSN: 2374-4235

Serum lactate is a potentially valuable biomarker for risk assessment for patients with sepsis, as hyperlactatemia is associated with elevated short-term mortality risks. However, the associations between hyperlactatemia and long-term clinical outcomes in sepsis survivors remain unknown. The objective of this study was to investigate whether hyperlactatemia at the time of hospitalisation for sepsis was associated with worse long-term clinical outcomes in sepsis survivors. In total, of 4983 sepsis survivors aged ≥ 20 years were enrolled in this study between January 1, 2012, and December 31, 2018. They were divided into low (≤18 mg/dL; n = 2698) and high (>18 mg/dL; n = 2285) lactate groups. The high lactate group was then matched 1:1 by propensity-score method to the low lactate group. The outcomes of interest were all-cause mortality, major adverse cardiac events (MACEs), ischaemic stroke, myocardial infarction, hospitalisation for heart failure, and end-stage renal disease. After propensity score matching, the high lactate group had greater risks of all-cause mortality (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.41-1.67), MACEs (HR 1.53, 95% CI 1.29-1.81), ischaemic stroke (HR 1.47, 95% CI 1.19-1.81), myocardial infarction (HR 1.52, 95% CI 1.17-1.99), and end-stage renal disease (HR 1.42, 95% CI 1.16-1.72). Subgroup analyses stratified by baseline renal function revealed almost similarity across groups. We found that hyperlactatemia is associated with long-term risks of mortality and MACEs in sepsis survivors. Physicians may consider more aggressive and prompter management of sepsis in patients who present with hyperlactatemia to improve long-term prognoses.