Serum Lactate Level Predicts Short-Term and Long-Term Mortality of HBV-ACLF Patients: A Prospective Study

Abstract

Background

Acute chronic liver failure (ACLF) is a high-mortality disease characterized by rapid deterioration of liver function and multiple organ failure. The aim of this study was to assess the short-term and long-term predictive values of serum lactate in HBV-ACLF patients to facilitate early treatment and thereby improve patient survival.

Methods

We conducted a single-center, observational prospective study of 108 hospitalized patients. Biochemical examination and demographic data were obtained within 24 hours of admission. Logistics analysis was used to determine whether serum levels were independently for prognosis of HBV-ACLF patients. The area under ROC curve evaluates the prediction accuracy compared to the existing score.

Results

Serum lactate levels in nonsurviving patients were significantly higher than those in surviving patients. Logistics analysis demonstrated that serum lactate was an independent risk factor for 28-day, 3-month, and 6-month mortality. ROC curve evaluates the prediction efficiencies of serum lactate for 28-day, 3-month, and 6-month mortality. The AUROCs of new scores by adding lactate (Child-Pugh+ lactate score, MELD+ lactate score, MELD-Na+ lactate score, CLIF-C OF+ lactate score, CLIF-SOFA+ lactate score, CLIF-C ACLF+ lactate score) were superior to those of existing scores, particularly the MELD score and MELD-Na score (P<0.05) at all time points.

Conclusion

Serum lactate can be used as an effective indicator to predict the short-term and long-term mortality in HBV-ACLF patients, and the predictive value of the MELD score and MELD-Na was improved by adjusting for lactate. Lactate testing at admission can be beneficial in prognostic assessment and clinical decision-making.

Keywords:

• acute-on-chronic liver failure
• HBV
• prognosis
• lactate
• scoring model

Abbreviations

HBV, hepatitis B virus; LC, liver cirrhosis; HE, hepatic encephalopathy; MELD, model for end-stage liver disease; HBsAg, hepatitis B surface antigen; HRS, hepatorenal syndrome; ACLF, acute-on-chronic liver failure; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALB, albumin; TBil, total bilirubin; PT, prothrombin time; INR, international normalized ratio; WBC, white blood cell count; PLT, platelet; Cr, creatinine; ALP, alkaline phosphatase; GGT, gamma-glutamyl transpeptidase; AUROC, the areas under the receiver operating characteristic curve; CLIF-C OF, CLIF consortium organ function; CLIF-SOFA, chronic liver failure-sequential organ failure assessment; CLIF-C ACLF, CLIF consortium acute-on-chronic liver failure.

Data Sharing Statement

The data sets generated and analyzed during this study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

All procedures involving human participants were approved by the Ethics Committee of The First Affiliated Hospital of Nanchang University (No.2013-0103). The study was performed in accordance with Helsinki Declaration. All subjects signed informed consent and volunteered to participate in the study.

Acknowledgments

The authors are thankful to the anonymous reviewers for their comments.

Disclosure

The authors declare that they have no competing interests. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (grant no. 81960120) and the “Gan-Po Talent 555” Project of Jiangxi Province.