What factor is used to predict outcomes in patients with lactic acidosis, and might lactic acidosis be related to prognosis in coronavirus disease 2019 (COVID-19)?

Updated: Dec 09, 2020
  • Author: Bret A Nicks, MD, MHA; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Lactate levels have been well described to correlate with the presence of tissue hypoperfusion in shock. Elevated levels have been shown to be correlated with increased mortality. Serum lactate levels above 4 mmol/L were associated with a survival of only 11% in critically ill patients in the intensive care unit (ICU) if persistent after 24 hours. The concept of lactate clearance remains a topic of focus in sepsis management. [9, 18, 22, 17] Further studies have demonstrated an association between a 12-hour rise in lactate concentration above 2.5 mmol/L and multisystem organ failure. [6, 7]

The duration and degree of increased serum lactic acid appear to predict morbidity and mortality. Abramson et al identified 100% survival with normalization of serum lactate concentration (< 2 mmol/L) within the first 24 hours following multiple trauma, 78% survival if normalization occurred in 24-48 hours, and only 14% survival if after 48 hours. [22]

The coronavirus disease 2019 (COVID-19) pandemic of 2020 may further highlight lactic acidosis as one of many markers that may indicate intensive care admission or prognosis in disease. To date, however, no COVID-19 morbidity or mortality data has been published specific to lactic acidosis or lactate clearance.


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