Background
Hyperlactatemia is defined by a
lactate concentration of >2 mmol/L, and a
lactate concentration of above >4 mmol/L is commonly used to define severe
hyperlactatemia. It is a common disorder in
critically ill patients and is associated with adverse prognosis.
Diabetes mellitus(DM) can also be associated with increased
lactate levels at baseline. In this study, we aimed to document the development of severe
hyperlactatemia in acute situations among patients with and without DM, to analyze potential contributors to
lactate elevation and their impact on mortality, and to analyze whether
lactate concentrations of >4 mmol/L have equal prognostic significance in patients with and without DM. Methodology A retrospective, cross-sectional study was performed among patients admitted to our internal medicine wards in the context of
acute disease with
lactate concentrations of ≥2 mmol/L. Data were collected regarding age, sex, highest
lactate concentrations, cause of
hyperlactatemia, DM, and mortality. Statistical analysis was performed using SPSS version 23. Results In total, 151 patients with
lactate levels of ≥2 mmol/L were analyzed. The mean age of the patients was 78.2 ± 14.9 years, and 55% of the patients were female. Overall, 55.6% of the patients had DM, as well as higher lactatemia of 6.3 ± 3.4 mmol/L (vs 5.1 ± 3.2 in non-DM patients, p = 0.003), with the majority reaching values of >4 mmol/L (vs 34.8% in non-DM patients). When potential contributors to the development of severe
hyperlactatemia (
lactate >4 mmol/L) were analyzed in DM patients,
metformin consumption concomitantly with factors potentiating its accumulation,
sepsis/
septic shock,
ischemia, and
neoplasia were the most frequently identified contributors. In non-DM patients, the three former factors were also the most frequently reported. The 30-day mortality rate was 25.82%, with deceased patients also displaying a higher lactatemia of 6.5 ± 3.2 mmol/L (vs. 5.5 ± 3.3 mmol/L in patients who survived) (p = 0.037). In multivariate analysis,
lactate values of >4 mmol/L were an independent predictor of mortality in the entire sample and in the subgroup without DM, but not in DM patients. Conclusions In our sample, patients with DM had higher
lactate levels than non-DM patients. Our analysis raises the possibility that the same
lactate values may not have equal capacity to assess prognosis in acute situations in patients with and without DM. Large-scale studies are needed to optimize cut-off points for lactatemia in patients with high baseline values, such as DM patients.