870: Lactate Clearance in Patients With Liver Cirrhosis and Sepsis

Introduction: Surviving Sepsis guidelines recommend lactate clearance as an important resuscitation goal in the management of sepsis. Specifically, lactate clearance (LCl) of 10% has been associated with improved outcomes in sepsis. However, lactate is predominantly cleared by the liver and has been shown to be elevated in patients with liver cirrhosis, when compared to those without liver disease. The rate of lactate clearance in this patient population and its association with Intensive Care Unit (ICU) outcomes has not been well documented. Our study aims to document the prognostic value of lactate clearance in septic patients with liver cirrhosis. Methods: This is a single-center, retrospective study of patients with liver cirrhosis admitted to a tertiary care Medical ICU with sepsis and septic shock meeting sepsis 3.0 criteria. All patients included in the analysis had an initial lactate > 2mmol/L. We analyzed baseline characteristics, lactate trends, and lactate clearance over the first 24 hours of ICU admission, as well as their association with ICU mortality. Receiver operating characteristic (ROC) curve was used to determine the optimal time period and cutoff for lactate clearance. A Cox proportional hazard model was used to assess the association of lactate clearance to 30-day ICU mortality. Results: A total of 490 patients were included in the analysis, of whom 266 (54.3%) survived ICU admission. Compared to non-survivors, survivors had lower baseline lactate (3.8 vs 5.5 mmol/L), lactate at 6-12 hours (3.2 vs 6.8 mmol/L), and 12-24 hours (2.8 vs 6.8 mmol/L). Lactate clearance was significantly higher in survivors compared to non-survivors at 12 hours (17.3% vs -9.4%) and 24 hours (27.1 vs -18.3%). Lactate clearance of >10% in the first 12-24 hours of ICU admission with sepsis or septic shock was associated with improved 30-day ICU mortality (HR = 0.64). Conclusions: Although lactate clearance is impaired in liver disease, a lactate clearance of less than 10% in the first 24 hours of admission is associated with increased ICU mortality. To our knowledge, this is the first study that has investigated lactate trends and its association with ICU outcomes in this unique population.