From the Guidelines
Lactic acidosis is a significant indicator of poor prognosis and increased mortality in patients with liver injury, particularly in acute-on-chronic liver failure and acute liver failure.
Key Points
- Lactate levels are associated with the number of organ failures and mortality in critically ill patients with cirrhosis, as seen in the MELD-LA model which outperforms MELD and other scores in predicting in-hospital mortality 1.
- In acute liver failure (ALF), impaired hepatic glucose production and lactate clearance lead to severe derangement of carbohydrate, protein, and lipid metabolism, resulting in hyper-aminoacidemia and hyper-ammonemia 1.
- The presence of lactic acidosis in liver injury requires intensive care support, careful attention to fluid management, hemodynamics, and metabolic parameters, as well as surveillance for and treatment of infection 1.
- Monitoring of lactate levels, along with other parameters such as coagulation parameters, complete blood counts, metabolic panels, and arterial blood gas, is crucial in managing patients with liver injury.
- The use of MELD-LA scores, which incorporate lactate levels, can help predict mortality and guide management decisions in patients with liver injury 1.
From the Research
Significance of Lactic Acidosis in Liver Injury
- Lactic acidosis in end-stage liver disease (ESLD) patients is associated with increased morbidity and mortality 2
- The condition is characterized by increased lactate production and impaired clearance, leading to severe acidemia 2
- Lactic acidosis in critically ill patients with liver disease is associated with clinical evidence of shock and increased hospital mortality 3
- Elevated lactate levels can be an indicator of liver dysfunction, rejection, or other significant causes, such as posttransplant lymphoproliferative disorder 4
Role of Lactate and Lactate Metabolism in Liver Diseases
- Lactate is not only a metabolic substrate that provides energy but also a signaling molecule that regulates cellular functions under pathophysiological conditions 5
- Abnormalities of lactate and lactate metabolism can lead to the development of liver disease, and lactate-related genes can be used for predicting the prognosis of liver disease 5
- Targeting lactate production, regulating lactate transport, and modulating lactylation may be potential treatment approaches for liver disease 5
Clinical Implications and Treatment
- Prompt recognition and treatment of the underlying causes of lactic acidosis remain the cornerstone of treatment 6
- Currently, there is no therapy specifically designed to lower arterial blood lactate levels that has reduced mortality significantly 6
- Perioperative management of lactic acidosis and associated severe acidemia is crucial in ESLD patients undergoing partial hepatectomy or liver transplantation 2