Rol del lactato en pacientes con falla hepática
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jul 1, 2021
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Resumen
Desde finales del siglo XX, los niveles de lactato han sido estudiados como marcador pronostico en los pacientes críticamente enfermos y como meta en su reanimación. En pacientes con enfermedad hepática la interpretación de los niveles de lactato presenta cierta dificultad dado su mecanismo de producción fisiopatológico. Sin embargo, existe evidencia sobre la relación de los niveles de lactato y mortalidad en el paciente con enfermedad hepática aguda o crónica en el paciente críticamente enfermo. Además, se ha postulado el lactato como predictor de beneficio de trasplante hepático y marcador pronostico temprano posterior al trasplante hepático. De acuerdo con lo anterior, es relevante el estudio e interpretación adecuada del lactato en los pacientes con enfermedad hepática.
Keywords
hiperlactatemia, fallo hepático, sepsis, enfermedad critica, trasplante de hígadohyperlactatemia, liver failure, sepsis, critical care, liver transplantation
References
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2. Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970. doi:10.1161/01.CIR.41.6.989
3. Peretz DI, Mcgregor M, Dossetor JB. Lactic acidosis: a clinically significant aspect of shock. Can Med Assoc J. 1964.
4. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013. doi:10.1056/NEJMra1208943
5. Vincent JL, Dufaye P, Berre J, Leeman M, Degaute JP, Kahn RJ. Serial lactate determinations during circulatory shock. Crit Care Med. 1983. doi:10.1097/00003246-198306000-00012
6. Orringer CE, Eustace JC, Wunsch CD, Gardner LB. Natural History of Lactic Acidosis after Grand-Mal Seizures. N Engl J Med. 1977. doi:10.1056/nejm197710132971502
7. Vincent JL, e Silva AQ, Couto L, Taccone FS. The value of blood lactate kinetics in critically ill patients: A systematic review. Crit Care. 2016. doi:10.1186/S13054-016-1403-5
8. Jansen TC, Van Bommel J, Schoonderbeek FJ, et al. Early lactate-guided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010. doi:10.1164/rccm.200912-1918OC
9. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004. doi:10.1097/01.CCM.0000117317.18092.E4
10. Hernandez G, Bellomo R, Bakker J. The ten pitfalls of lactate clearance in sepsis. Intensive Care Med. 2019. doi:10.1007/s00134-018-5213-x
11. Alegría L, Vera M, Dreyse J, et al. A hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients: a proof-of-concept study. Ann Intensive Care. 2017. doi:10.1186/s13613-017-0253-x
12. Hernandez G, Luengo C, Bruhn A, et al. When to stop septic shock resuscitation: clues from a dynamic perfusion monitoring. Apidologie. 2014. doi:10.1186/s13613-014-0030-z
13. Nichol AD, Egi M, Pettila V, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: A retrospective multi-centre study. Crit Care. 2010. doi:10.1186/cc8888
14. Levy B. Lactate and shock state: The metabolic view. Curr Opin Crit Care. 2006. doi:10.1097/01.ccx.0000235208.77450.15
15. Garcia-Alvarez M, Marik P, Bellomo R. Stress hyperlactataemia: Present understanding and controversy. Lancet Diabetes Endocrinol. 2014. doi:10.1016/S2213-8587(13)70154-2
16. Almenoff PL, Leavy J, Weil MH, Goldberg NB, Vega D, Rackow EC. Prolongation of the half-life of lactate after maximal exercise in patients with hepatic dysfunction. Crit Care Med. 1989. doi:10.1097/00003246-198909000-00004
17. Jeppesen JB, Mortensen C, Bendtsen F, Møller S. Lactate metabolism in chronic liver disease. Scand J Clin Lab Invest. 2013. doi:10.3109/00365513.2013.773591
18. Clemmesen JO, Hoy CE, Kondrup J, Ott P. Splanchnic metabolism of fuel substrates in acute liver failure. J Hepatol. 2000;33(6):941-948. doi:10.1016/S0168-8278(00)80126-9
19. Yao H, Sadoshima S, Fujii K, et al. Cerebrospinal fluid lactate in patients with hepatic encephalopathy. Eur Neurol. 1987. doi:10.1159/000116153
20. Tofteng F, Larsen FS. Monitoring extracellular concentrations of lactate, glutamate, and glycerol by in vivo microdialysis in the brain during liver transplantation in acute liver failure. Liver Transplant. 2002;8(3):302-305. doi:10.1053/jlts.2002.32283
21. Lai JC, Cooper AJ. Brain alpha-ketoglutarate dehydrogenase complex: kinetic properties, regional distribution, and effects of inhibitors. J Neurochem. 1986;47(5):1376-1386. doi:10.1111/j.1471-4159.1986.tb00768.x
22. Eefsen M, Dethloff T, Frederiksen HJ, Hauerberg J, Hansen BA, Larsen FS. Comparison of terlipressin and noradrenalin on cerebral perfusion, intracranial pressure and cerebral extracellular concentrations of lactate and pyruvate in patients with acute liver failure in need of inotropic support. J Hepatol. 2007;47(3):381-386. doi:10.1016/j.jhep.2007.04.015
23. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Crit Care Med. 2018. doi:10.1097/CCM.0000000000003119
24. Drolz A, Horvatits T, Rutter K, et al. Lactate Improves Prediction of Short-Term Mortality in Critically Ill Patients With Cirrhosis: A Multinational Study. Hepatology. 2019;69(1):258-269. doi:10.1002/hep.30151
25. Freire Jorge P, Wieringa N, de Felice E, van der Horst ICC, Oude Lansink A, Nijsten MW. The association of early combined lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients. Crit Care. 2017;21(1):1-11. doi:10.1186/s13054-017-1785-z
26. Cardoso FS, Abraldes JG, Sy E, et al. Lactate and number of organ failures predict intensive care unit mortality in patients with acute-on-chronic liver failure. Liver Int. 2019;39(7):1271-1280. doi:10.1111/liv.14083
27. Gao F, Huang XL, Cai MX, et al. Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: A multicenter study. Aging (Albany NY). 2019;11(13):4446-4462. doi:10.18632/aging.102062
28. Schmidt LE, Larsen FS. Prognostic implications of hyperlactatemia, multiple organ failure, and systemic inflammatory response syndrome in patients with acetaminophen-induced acute liver failure. Crit Care Med. 2006;34(2):337-343. doi:10.1097/01.CCM.0000194724.70031.B6
29. MacQuillan GC, Seyam MS, Nightingale P, Neuberger JM, Murphy N. Blood lactate but not serum phosphate levels can predict patient outcome in fulminant hepatic failure. Liver Transplant. 2005;11(9):1073-1079. doi:10.1002/lt.20427
30. Du WB, Pan XP, Li LJ. Prognostic models for acute liver failure. Hepatobiliary Pancreat Dis Int. 2010;9(2):122-128.
31. Novelli G, Rossi M, Ferretti G, et al. Predictive criteria for the outcome of patients with acute liver failure treated with the albumin dialysis molecular adsorbent recirculating system. Ther Apher Dial. 2009;13(5):404-412. doi:10.1111/j.1744-9987.2009.00759.x
32. Hadem J, Stiefel P, Bahr MJ, et al. Prognostic Implications of Lactate, Bilirubin, and Etiology in German Patients With Acute Liver Failure. Clin Gastroenterol Hepatol. 2008;6(3):339-345. doi:10.1016/j.cgh.2007.12.039
33. Westbrook RH, Yeoman AD, Joshi D, et al. Outcomes of severe pregnancy-related liver disease: Refining the role of transplantation. Am J Transplant. 2010;10(11):2520-2526. doi:10.1111/j.1600-6143.2010.03301.x
34. Chandnani S, Rathi P, Udgirkar SS, Sonthalia N, Contractor Q, Jain S. Clinical utility of risk scores in variceal bleeding. Arq Gastroenterol. 2019;56(3):286-293. doi:10.1590/s0004-2803.201900000-54
35. Tsai MH, Chen YC, Lien JM, et al. Hemodynamics and metabolic studies on septic shock in patients with acute liver failure. J Crit Care. 2008;23(4):468-472. doi:10.1016/j.jcrc.2008.04.006
36. Okonkwo E, Rozario N, Heffner AC. Presentation and outcomes of end stage liver disease patients presenting with septic shock to the emergency department. Am J Emerg Med. 2020;38(7):1408-1413. doi:10.1016/j.ajem.2019.11.039
37. Burra P, Burroughs A, Graziadei I, et al. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 2016. doi:10.1016/j.jhep.2015.10.006
38. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: A critical analysis of the evidence. Chest. 2002. doi:10.1378/chest.121.6.2000
39. Cardoso NM, Silva T, Basile-Filho A, Mente ED, Castro-E-Silva O. A new formula as a predictive score of post-liver transplantation outcome: Postoperative MELD-lactate. Transplant Proc. 2014;46(5):1407-1412. doi:10.1016/j.transproceed.2013.12.067
40. Basile-Filho A, Nicolini EA, Auxiliadora-Martins M, Silva Jr O de C e. The use of perioperative serial blood lactate levels, the APACHE II and the postoperative MELD as predictors of early mortality after liver transplantation. Acta Cir Bras. 2011;26(6):535-540. doi:10.1590/s0102-86502011000600021
41. Wu JF, Wu RY, Chen J, Ou-Yang B, Chen MY, Guan XD. Early lactate clearance as a reliable predictor of initial poor graft function after orthotopic liver transplantation. Hepatobiliary Pancreat Dis Int. 2011;10(6):587-592. doi:10.1016/S1499-3872(11)60100-8
2. Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970. doi:10.1161/01.CIR.41.6.989
3. Peretz DI, Mcgregor M, Dossetor JB. Lactic acidosis: a clinically significant aspect of shock. Can Med Assoc J. 1964.
4. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013. doi:10.1056/NEJMra1208943
5. Vincent JL, Dufaye P, Berre J, Leeman M, Degaute JP, Kahn RJ. Serial lactate determinations during circulatory shock. Crit Care Med. 1983. doi:10.1097/00003246-198306000-00012
6. Orringer CE, Eustace JC, Wunsch CD, Gardner LB. Natural History of Lactic Acidosis after Grand-Mal Seizures. N Engl J Med. 1977. doi:10.1056/nejm197710132971502
7. Vincent JL, e Silva AQ, Couto L, Taccone FS. The value of blood lactate kinetics in critically ill patients: A systematic review. Crit Care. 2016. doi:10.1186/S13054-016-1403-5
8. Jansen TC, Van Bommel J, Schoonderbeek FJ, et al. Early lactate-guided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010. doi:10.1164/rccm.200912-1918OC
9. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004. doi:10.1097/01.CCM.0000117317.18092.E4
10. Hernandez G, Bellomo R, Bakker J. The ten pitfalls of lactate clearance in sepsis. Intensive Care Med. 2019. doi:10.1007/s00134-018-5213-x
11. Alegría L, Vera M, Dreyse J, et al. A hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients: a proof-of-concept study. Ann Intensive Care. 2017. doi:10.1186/s13613-017-0253-x
12. Hernandez G, Luengo C, Bruhn A, et al. When to stop septic shock resuscitation: clues from a dynamic perfusion monitoring. Apidologie. 2014. doi:10.1186/s13613-014-0030-z
13. Nichol AD, Egi M, Pettila V, et al. Relative hyperlactatemia and hospital mortality in critically ill patients: A retrospective multi-centre study. Crit Care. 2010. doi:10.1186/cc8888
14. Levy B. Lactate and shock state: The metabolic view. Curr Opin Crit Care. 2006. doi:10.1097/01.ccx.0000235208.77450.15
15. Garcia-Alvarez M, Marik P, Bellomo R. Stress hyperlactataemia: Present understanding and controversy. Lancet Diabetes Endocrinol. 2014. doi:10.1016/S2213-8587(13)70154-2
16. Almenoff PL, Leavy J, Weil MH, Goldberg NB, Vega D, Rackow EC. Prolongation of the half-life of lactate after maximal exercise in patients with hepatic dysfunction. Crit Care Med. 1989. doi:10.1097/00003246-198909000-00004
17. Jeppesen JB, Mortensen C, Bendtsen F, Møller S. Lactate metabolism in chronic liver disease. Scand J Clin Lab Invest. 2013. doi:10.3109/00365513.2013.773591
18. Clemmesen JO, Hoy CE, Kondrup J, Ott P. Splanchnic metabolism of fuel substrates in acute liver failure. J Hepatol. 2000;33(6):941-948. doi:10.1016/S0168-8278(00)80126-9
19. Yao H, Sadoshima S, Fujii K, et al. Cerebrospinal fluid lactate in patients with hepatic encephalopathy. Eur Neurol. 1987. doi:10.1159/000116153
20. Tofteng F, Larsen FS. Monitoring extracellular concentrations of lactate, glutamate, and glycerol by in vivo microdialysis in the brain during liver transplantation in acute liver failure. Liver Transplant. 2002;8(3):302-305. doi:10.1053/jlts.2002.32283
21. Lai JC, Cooper AJ. Brain alpha-ketoglutarate dehydrogenase complex: kinetic properties, regional distribution, and effects of inhibitors. J Neurochem. 1986;47(5):1376-1386. doi:10.1111/j.1471-4159.1986.tb00768.x
22. Eefsen M, Dethloff T, Frederiksen HJ, Hauerberg J, Hansen BA, Larsen FS. Comparison of terlipressin and noradrenalin on cerebral perfusion, intracranial pressure and cerebral extracellular concentrations of lactate and pyruvate in patients with acute liver failure in need of inotropic support. J Hepatol. 2007;47(3):381-386. doi:10.1016/j.jhep.2007.04.015
23. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Crit Care Med. 2018. doi:10.1097/CCM.0000000000003119
24. Drolz A, Horvatits T, Rutter K, et al. Lactate Improves Prediction of Short-Term Mortality in Critically Ill Patients With Cirrhosis: A Multinational Study. Hepatology. 2019;69(1):258-269. doi:10.1002/hep.30151
25. Freire Jorge P, Wieringa N, de Felice E, van der Horst ICC, Oude Lansink A, Nijsten MW. The association of early combined lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients. Crit Care. 2017;21(1):1-11. doi:10.1186/s13054-017-1785-z
26. Cardoso FS, Abraldes JG, Sy E, et al. Lactate and number of organ failures predict intensive care unit mortality in patients with acute-on-chronic liver failure. Liver Int. 2019;39(7):1271-1280. doi:10.1111/liv.14083
27. Gao F, Huang XL, Cai MX, et al. Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: A multicenter study. Aging (Albany NY). 2019;11(13):4446-4462. doi:10.18632/aging.102062
28. Schmidt LE, Larsen FS. Prognostic implications of hyperlactatemia, multiple organ failure, and systemic inflammatory response syndrome in patients with acetaminophen-induced acute liver failure. Crit Care Med. 2006;34(2):337-343. doi:10.1097/01.CCM.0000194724.70031.B6
29. MacQuillan GC, Seyam MS, Nightingale P, Neuberger JM, Murphy N. Blood lactate but not serum phosphate levels can predict patient outcome in fulminant hepatic failure. Liver Transplant. 2005;11(9):1073-1079. doi:10.1002/lt.20427
30. Du WB, Pan XP, Li LJ. Prognostic models for acute liver failure. Hepatobiliary Pancreat Dis Int. 2010;9(2):122-128.
31. Novelli G, Rossi M, Ferretti G, et al. Predictive criteria for the outcome of patients with acute liver failure treated with the albumin dialysis molecular adsorbent recirculating system. Ther Apher Dial. 2009;13(5):404-412. doi:10.1111/j.1744-9987.2009.00759.x
32. Hadem J, Stiefel P, Bahr MJ, et al. Prognostic Implications of Lactate, Bilirubin, and Etiology in German Patients With Acute Liver Failure. Clin Gastroenterol Hepatol. 2008;6(3):339-345. doi:10.1016/j.cgh.2007.12.039
33. Westbrook RH, Yeoman AD, Joshi D, et al. Outcomes of severe pregnancy-related liver disease: Refining the role of transplantation. Am J Transplant. 2010;10(11):2520-2526. doi:10.1111/j.1600-6143.2010.03301.x
34. Chandnani S, Rathi P, Udgirkar SS, Sonthalia N, Contractor Q, Jain S. Clinical utility of risk scores in variceal bleeding. Arq Gastroenterol. 2019;56(3):286-293. doi:10.1590/s0004-2803.201900000-54
35. Tsai MH, Chen YC, Lien JM, et al. Hemodynamics and metabolic studies on septic shock in patients with acute liver failure. J Crit Care. 2008;23(4):468-472. doi:10.1016/j.jcrc.2008.04.006
36. Okonkwo E, Rozario N, Heffner AC. Presentation and outcomes of end stage liver disease patients presenting with septic shock to the emergency department. Am J Emerg Med. 2020;38(7):1408-1413. doi:10.1016/j.ajem.2019.11.039
37. Burra P, Burroughs A, Graziadei I, et al. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 2016. doi:10.1016/j.jhep.2015.10.006
38. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: A critical analysis of the evidence. Chest. 2002. doi:10.1378/chest.121.6.2000
39. Cardoso NM, Silva T, Basile-Filho A, Mente ED, Castro-E-Silva O. A new formula as a predictive score of post-liver transplantation outcome: Postoperative MELD-lactate. Transplant Proc. 2014;46(5):1407-1412. doi:10.1016/j.transproceed.2013.12.067
40. Basile-Filho A, Nicolini EA, Auxiliadora-Martins M, Silva Jr O de C e. The use of perioperative serial blood lactate levels, the APACHE II and the postoperative MELD as predictors of early mortality after liver transplantation. Acta Cir Bras. 2011;26(6):535-540. doi:10.1590/s0102-86502011000600021
41. Wu JF, Wu RY, Chen J, Ou-Yang B, Chen MY, Guan XD. Early lactate clearance as a reliable predictor of initial poor graft function after orthotopic liver transplantation. Hepatobiliary Pancreat Dis Int. 2011;10(6):587-592. doi:10.1016/S1499-3872(11)60100-8
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Lombo Moreno, C. E., & Suarez Quintero, C. Y. . (2021). Rol del lactato en pacientes con falla hepática . Universitas Medica, 62(3). https://doi.org/10.11144/Javeriana.umed62-3.lact
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