Open Access Highly Accessed Open Badges Research

Even Mild Hyperlactatemia Is Associated with Increased Mortality in Critically Ill Patients

Asgar H Rishu1, Raymond Khan1, Hasan M Al-Dorzi1, Hani M Tamim2, Saad Al-Qahtani1, Ghassan Al-Ghamdi1 and Yaseen M Arabi1*

Author Affiliations

1 Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, PO box 22490, Riyadh, Saudi Arabia, 11426

2 King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Sciences, PO box 22490, Riyadh, Saudi Arabia, 11426

For all author emails, please log on.

Critical Care 2013, 17:R197  doi:10.1186/cc12891

Published: 11 September 2013



The clinical significance of elevation of lactate levels within the reference range is not well studied. The objective of this study was to determine the best cutoff threshold for serum lactate within the reference range (0.01 to 2.00 mM) that best discriminated between survivors and nonsurvivors of critical illness and to examine the association between relative hyperlactatemia (lactate above the identified threshold) and mortality.


This was a retrospective cohort study of adult patients admitted to the medical-surgical intensive care unit (ICU) of a tertiary care academic center. Youden index was calculated to identify the best lactate cutoff threshold that discriminated between survivors and nonsurvivors. Patients with lactate above the identified threshold were defined as having relative hyperlactatemia. Multivariate logistic regression, adjusting for baseline variables, was performed to determine the relationship between the above two ranges of lactate levels and mortality. In addition, a test of interaction was performed to assess the effect of selected subgroups on the association between relative hyperlactatemia and hospital mortality.


During the study period, 2,157 patients were included in the study with mean lactate of 1.3 ± 0.4 mM, age of 55.1 ± 20.3 years, and acute physiology and chronic health evaluation (APACHE) II score of 22.1 ± 8.2. Vasopressors were required in 42.4%. Lactate of 1.35 mM was found to be the best cutoff threshold for the whole cohort. Relative hyperlactatemia was associated with increased hospital mortality (adjusted odds ratio (aOR), 1.60, 95% confidence interval (CI) 1.29 to 1.98), and ICU mortality (aOR, 1.66; 95% CI, 1.26 to 2.17) compared with a lactate level of 0.01 to 1.35 mM. This association was consistent among all examined subgroups.


Relative hyperlactatemia (lactate of 1.36 to 2.00 mM) within the first 24 hours of ICU admission is an independent predictor of hospital and ICU mortality in critically ill patients.