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Value of serial serum lactate evaluation in liver transplant patients at the ICU
Critical Care volume 10, Article number: P313 (2006)
To determine the role of serial serum lactate evaluation in patients submitted to orthotopic liver transplant (OLT) and its correlation with classic hepatic laboratorial parameters.
A retrospective case-control study in a 16-bed medical-surgical ICU.
Patients submitted to OLT with an ICU stay >72 hours were retrospectively studied during the immediate postsurgery period at the ICU. For comparative purposes, a control group of OTL patients that were discharged from the ICU uneventfully was studied (n = 23, mean age years, mean ICU stay days). Patients with complications were evaluated (n = 17, mean age years, mean ICU stay days): nine vascular complications (seven with documented venous thrombosis, two with documented arterial thrombosis), one hepatic aspergillosis, one acute cellular rejection, two graft primary nonfunction, one biliary system stenosis and three intrahepatic colestasis. These patients were further divided based on a biochemical pattern of liver laboratory parameters: hepatocellular (increased ALT and AST) or cholestatic (increased GGT and total bilirubin). Serial serum lactate measurements were evaluated, and compared with the biochemical profile of liver function parameters. Hemodynamic instability during surgery was also considered, as well as APACHE II and SAPS II scores. A statistical analysis was performed. Patients with twofold and 1.5-fold increases in any biochemical parameter were identified and were cross-examined by a chi-squared test, considering P < 0.05 significant.
In the control group, serum lactate decreased rapidly, along with other biochemical parameters. Patients with complications presented a higher serum lactate at first measurement (9.4 vs 6.7 mmol/l, P = 0.046), and a higher SAPS II score (22.3 ± 9.6 vs 40.1 ± 15.5, P < 0.001). Female sex and hemodynamic instability also correlated with the presence of complications. All vascular complications were characterized by an increase in serum AST and ALT. A 1.5-fold increase in lactate correlated strongly with a similar increase in ALT and AST (P < 0.001) and less with an increase in cholestatic parameters (P = 0.02). A twofold increase in serum lactate correlated well with a similar increase in AST and ALT (P = 0.005) but not with cholestatic parameters.
A 1.5-fold increase in serum lactate after OLT correlated well with all complications observed. A twofold increase correlated only with complications that led to an increase in ALT and AST, particularly vascular.
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Machado, M., Fernandes, A., Ferreira, C. et al. Value of serial serum lactate evaluation in liver transplant patients at the ICU. Crit Care 10, P313 (2006). https://doi.org/10.1186/cc4660
- Orthotopic Liver Transplant
- Hemodynamic Instability
- Serum Lactate
- Acute Cellular Rejection