A note on lactic acid clearance

The two components of lactic acid may very well predict and correlate with ICU mortality.

1) Duration, and
2) Degree

Abramson et al showed more than 23 years ago that if lactic acid normalizes within 24 hours following multiple trauma, survival is 100% predicted. But if it takes more than 48 hours to normalize, survival prediction gets down to only 14%.

Similarly other works have shown that if lactic acid remains elevated more than 4 mmol/L after 24 hours of ICU admission, likelihood of survival is only 11%.



Reference:

1. Abramson D, Scalea TM, Hitchcock R, Trooskin SZ, Henry SM, Greenspan J. Lactate clearance and survival following injury. J Trauma. 1993 Oct. 35(4):584-8. 

2.  Jones AE. Point: should lactate clearance be substituted for central venous oxygen saturation as goals of early severe sepsis and septic shock therapy? Yes. Chest. 2011 Dec. 140(6):1406-8. 

3. Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010 Feb 24. 303(8):739-46.