From the Guidelines
Causes of Increased Lactate in MSSA Sepsis, ARDS, OS ASD, and PM VSD
Increased lactate in a patient with Methicillin-sensitive Staphylococcus aureus (MSSA) sepsis, Acute Respiratory Distress Syndrome (ARDS), Ostium Secundum Atrial Septal Defect (OS ASD), and Patent Membranous Ventricular Septal Defect (PM VSD) is primarily due to tissue hypoperfusion and hypoxia.
- Key factors contributing to elevated lactate levels include:
- Tissue hypoxia: Inadequate oxygen delivery to tissues, which can occur in sepsis due to impaired circulation, hypotension, or anemia 1.
- Accelerated aerobic glycolysis: Excess beta-adrenergic stimulation can lead to increased lactate production, even in the presence of adequate oxygen delivery 1.
- Liver dysfunction: Impaired lactate clearance by the liver can also contribute to elevated lactate levels 1.
- In the context of MSSA sepsis, ARDS, OS ASD, and PM VSD, sepsis-induced hypoperfusion is a significant contributor to increased lactate levels, as it leads to inadequate tissue oxygenation and perfusion 1.
- The presence of cardiac defects (OS ASD and PM VSD) may further exacerbate tissue hypoperfusion and hypoxia, contributing to elevated lactate levels.
- ARDS can also impair oxygen delivery to tissues, contributing to tissue hypoxia and increased lactate production.
- Guiding resuscitation to normalize lactate levels is suggested as a marker of tissue hypoperfusion, although the evidence is of low quality 1.
From the Research
Causes of Increased Lactate
- Increased lactate in a patient with Methicillin-sensitive Staphylococcus aureus (MSSA) sepsis, Acute Respiratory Distress Syndrome (ARDS), Ostium Secundum Atrial Septal Defect (OS ASD), and Patent Membranous Ventricular Septal Defect (PM VSD) can be caused by several factors, including:
- Tissue hypoxia or inflammation, which can lead to lactate release into the circulation 2
- Impaired tissue oxygen use, rather than impaired oxygen transport, as suggested by a study on hyperlactatemia in sepsis 3
- Pulmonary lactate release, which correlates with the severity of lung injury 2
- Endothelial dysfunction in sepsis-induced ARDS, which can be driven by H3K14la promoting SLC40A1/transferrin-mediated ferroptosis 4
- Elevated serum lactate levels have been associated with an increased risk of ARDS development in patients with severe sepsis 5
- The lungs of patients with sepsis and ARDS may become a source of lactate release into the circulation, contributing to increased lactate levels 2
Relationship Between Lactate and Sepsis
- Hyperlactatemia in sepsis may derive from a prevalent impairment of oxygen supply/demand and/or oxygen use 3
- Lactate levels have been shown to correlate strongly with mortality in patients with sepsis 3
- The origin of excess lactate in sepsis can be modified according to the origin of excess lactate, with impaired tissue oxygen use being a more frequent cause than impaired oxygen transport 3