Letter to the Director
Is it correct to include lactate in the new septic shock definition?
¿Es correcta la inclusión del lactato en la nueva definición de sepsis?
R. Uña Orejón
, I. Huercio Martínez, E. Mateo Torres, C. Jofré Escudero, M. del Prado Ureta Tolsada
Corresponding author
Hospital Universitario La Paz, Madrid, Spain
Read
6
Timeswas read the article
2
Total PDF
4
Total HTML
Share statistics
array:24 [ "pii" => "S2341192917302068" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.09.013" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "864" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:121" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S003493561730213X" "issn" => "00349356" "doi" => "10.1016/j.redar.2017.09.005" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "864" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Esp Anestesiol Reanim. 2018;65:121" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 197 "formatos" => array:2 [ "HTML" => 170 "PDF" => 27 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "¿Es correcta la inclusión del lactato en la nueva definición de sepsis?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "121" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Is it correct to include lactate in the new septic shock definition?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Uña Orejón, I. Huercio Martínez, E. Mateo Torres, C. Jofré Escudero, M. del Prado Ureta Tolsada" "autores" => array:5 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Uña Orejón" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Huercio Martínez" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Mateo Torres" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Jofré Escudero" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "del Prado Ureta Tolsada" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192917302068" "doi" => "10.1016/j.redare.2017.09.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917302068?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S003493561730213X?idApp=UINPBA00004N" "url" => "/00349356/0000006500000002/v1_201801100532/S003493561730213X/v1_201801100532/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192917302019" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.12.002" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "815" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:122-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 2 "PDF" => 2 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Incidental finding of thrombus in patent foramen ovale in patient with major pulmonary embolism" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "122" "paginaFinal" => "123" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgo incidental de trombo en foramen oval permeable en un paciente con tromboembolismo pulmonar masivo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 838 "Ancho" => 975 "Tamanyo" => 72339 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mid oesophageal view showing interatrial septum and thrombus passing from the RA to the LA through the PFO.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Alarcón Pérez, E. Novoa Lago, Á. Irabien Ortiz, J. Hortal Iglesias" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Alarcón Pérez" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Novoa Lago" ] 2 => array:2 [ "nombre" => "Á." "apellidos" => "Irabien Ortiz" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Hortal Iglesias" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617301020" "doi" => "10.1016/j.redar.2017.03.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617301020?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917302019?idApp=UINPBA00004N" "url" => "/23411929/0000006500000002/v1_201802090832/S2341192917302019/v1_201802090832/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192917302032" "issn" => "23411929" "doi" => "10.1016/j.redare.2017.12.003" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "857" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:119-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Oxygen dissolved in plasma does matter. Tissue oxygen monitoring to assess the feasability of a microvascular flap in a patient undergoing hyperbaric oxygen therapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "119" "paginaFinal" => "120" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El oxígeno disuelto en plasma sí importa… Empleo de la monitorización tisular de oxígeno para valorar la viabilidad de un colgajo microvascular en paciente sometido a oxigenoterapia hiberbárica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1050 "Ancho" => 1867 "Tamanyo" => 237058 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Outside of the hyperbaric chamber in the Hospital Central de la Defensa Gómez Ulla of Madrid. (B) Treatment of the patient inside the OHB chamber. (C) Patient's leg after the first surgery. (D) Invos<span class="elsevierStyleSup">®</span> monitoring of tissue oxygen saturation in the healthy area (ankle: 68) and the graft (leg: 67) after hyperbaric oxygen therapy. Photographs taken by the authors.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Navarro Suay, M.N. Escolán Gonzalvo, M.A. de Nicolás Álvarez, M.Á. Brinquis Crespo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Navarro Suay" ] 1 => array:2 [ "nombre" => "M.N." "apellidos" => "Escolán Gonzalvo" ] 2 => array:2 [ "nombre" => "M.A." "apellidos" => "de Nicolás Álvarez" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Brinquis Crespo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617302037" "doi" => "10.1016/j.redar.2017.08.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617302037?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917302032?idApp=UINPBA00004N" "url" => "/23411929/0000006500000002/v1_201802090832/S2341192917302032/v1_201802090832/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Is it correct to include lactate in the new septic shock definition?" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "121" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Uña Orejón, I. Huercio Martínez, E. Mateo Torres, C. Jofré Escudero, M. del Prado Ureta Tolsada" "autores" => array:5 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Uña Orejón" "email" => array:1 [ 0 => "gorote90@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Huercio Martínez" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Mateo Torres" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Jofré Escudero" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "del Prado Ureta Tolsada" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitario La Paz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es correcta la inclusión del lactato en la nueva definición de sepsis?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The 3rd International Consensus Definition for Sepsis and Septic Shock recently confirmed the need to develop a new, easily understandable universal definition that would facilitate early and accurate detection. A group of experts defined sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Septic shock is now defined as a clinical construct of sepsis that requires vasopressors to maintain a mean arterial pressure ≥ 65<span class="elsevierStyleHsp" style=""></span>mm Hg with lactate > 2<span class="elsevierStyleHsp" style=""></span>mmol/L. Therefore, hyperlactataemia is now an important bio-marker of cellular dysfunction that is likely related to tissue hypoxia secondary to hypoperfusion. Thus, lactate levels were established as a prognostic marker for patients with shock, and lactate clearance, more than serum lactate levels, has been established as a prognosis marker for septic shock.</p><p id="par0015" class="elsevierStylePara elsevierViewall">However, these statements are based on conventional concepts and are currently being questioned in the light of recent trials.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Indeed, no correlation has been found between lactate levels and tissue oxygenation when muscular tissue pO<span class="elsevierStyleInf">2</span> is measured, even in late stages of septic shock.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Likewise, studies in experimental animals showed not correlation between hyperlactataemia and tissue hypoxia levels when septic shock was induced. Similar results were obtained when oxygen content was evaluated with hypoxia markers, regardless of whether it was studied in experimental animals or septic patients with increased lactate levels.</p><p id="par0025" class="elsevierStylePara elsevierViewall">New evidence suggests that sepsis-associated hyperlactataemia could be an adaptive response to stress, where adrenergic stimulation increases aerobic glycolysis. This adrenergic activation may improve energy demand through the aerobic pathway by a mitochondrial lactate oxidation complex that converts lactate back to pyruvate for entry into the Kreb's Cycle (36 ATP mol).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Traditionally, lactate had been long considered a byproduct of anaerobic metabolism, producing only 2<span class="elsevierStyleHsp" style=""></span>mol of ATP. By this logic, an increase in serum lactate would be an inherent consequence of anaerobic respiration in times of lack of oxygen. However, this approach is being overshadowed by a new hypothesis called “Lactate shuttle”, where a transporter facilitates lactate entry into the mitochondria in different tissues and can be used as an energy source under stress, thus reflecting an optimal energy recycle.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Furthermore, this same glycolytic product lactate may supply energy to highly threatened organs (brain, heart, kidney and liver), an effect known as a “Cell-cell lactate shuttle”.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Therefore, lactate may also reflect a defence mechanism against an insult. This was demonstrated by Wutrich,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> who showed a positive correlation between serum lactate levels and better prognosis in patients with shock.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, hyperlactataemia can still be used as a marker of oxygen debt, but an increase in serum levels may not always respond to a negative situation, but rather to an adaptive survival process to stress. Early lactate clearance may provide a better prognosis than a simple static value, and given the lack of an alternative, it is still a good bio-marker for early detection of septic shock. However, serum lactate may needed to be reconsidered as the only reliable marker of tissue hypoxia. Instead, it may represent an essential energy source for survival in septic shock.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Uña Orejón R, Huercio Martínez I, Mateo Torres E, Jofré Escudero C, del Prado Ureta Tolsada M. ¿Es correcta la inclusión del lactato en la nueva definición de sepsis? Rev Esp Anestesiol Reanim. 2018;65:121.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Shankar-Hari" 1 => "G.S. Phillips" 2 => "M. Levy" 3 => "C.W. Seymour" 4 => "V.X. Liu" 5 => "C.S. Deutschman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2016.0289" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2016" "volumen" => "315" "paginaInicial" => "775" "paginaFinal" => "787" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26903336" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation between muscle Na<span class="elsevierStyleSup">+</span>K<span class="elsevierStyleSup">+</span> ATPase activity and raised lactate concentrations in septic shock: a prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Levy" 1 => "S. Gibot" 2 => "P. Franck" 3 => "A. Cravoisy" 4 => "P.E. Bollaert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(05)71045-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2005" "volumen" => "365" "paginaInicial" => "871" "paginaFinal" => "875" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15752531" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mitochondrial lactate oxidation complex and an adaptive role for lactate production" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Hashimoto" 1 => "G.A. Brooks" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1249/MSS.0b013e31815fcb04" "Revista" => array:6 [ "tituloSerie" => "Med Sci Sports Exerc" "fecha" => "2008" "volumen" => "40" "paginaInicial" => "486" "paginaFinal" => "494" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18379211" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cell–cell and intracellular lactate shuttles" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.A. Brooks" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1113/jphysiol.2009.178350" "Revista" => array:6 [ "tituloSerie" => "J Physiol" "fecha" => "2009" "volumen" => "587" "paginaInicial" => "5591" "paginaFinal" => "5600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19805739" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early increase in arterial lactate concentration under epinephrine infusion is associated with a better prognosis during shock" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Wutrich" 1 => "D. Barraud" 2 => "M. Conrad" 3 => "A. Cravoisy-Popovic" 4 => "L. Nace" 5 => "P.E. Bollaert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SHK.0b013e3181e7e9ba" "Revista" => array:6 [ "tituloSerie" => "Shock" "fecha" => "2010" "volumen" => "34" "paginaInicial" => "4" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20523270" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006500000002/v1_201802090832/S2341192917302068/v1_201802090832/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000002/v1_201802090832/S2341192917302068/v1_201802090832/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917302068?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 4 | 2 | 6 |
