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This article is part of the supplement: 29th International Symposium on Intensive Care and Emergency Medicine

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Serum lactic acid in the evaluation of outcome in the ICU

A Khalaf, N Abouchala, M Jamil and M Kherallah

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King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

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Critical Care 2009, 13(Suppl 1):P503  doi:10.1186/cc7667

The electronic version of this article is the complete one and can be found online at:

Published:13 March 2009

© 2009 Khalaf et al; licensee BioMed Central Ltd.


The purpose of this study was to determine the utility of an initial serum lactate measurement for identifying high risk of death in patients admitted to the ICU.


In a cohort study at a tertiary-care nontrauma medical–surgical ICU, we included all ICU admissions (May 2007 to February 2008) from a prospectively collected ICU database. Patients' gender, age, admission physiologic measurements, lactic acid, and APACHE IV score were noted. Outcome was acute phase death (death within 3 days of admission) and inhospital death. Outcome was stratified by the initial serum lactic acid level in three groups: low, 0.0 to 2.0; intermediate, 2.1 to 3.9; high, 4.0 mmol/l or above.


Total of 882 patients were included in the study, acute phase death rates were 2.5%, in the low group, 5.1% in intermediate group and 8.1% in the high group, whereas inhospital mortality rates were 13.9%, 28.6%, and 38.7%, respectively. Acute-phase deaths and inhospital deaths increased linearly with lactate. An initial lactate ≥ 4.0 mmol/l was associated with at least a threefold higher odds ratio for both acute-phase deaths 2.8 (95% CI = 1.1 to 7.3) and inhospital mortality 3.4 (95% CI = 2.0 to 5.8).


An initial lactate ≥ 4.0 mmol/l substantially increases the probability of acute-phase death and inhospital mortality in critically ill patients.