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Publications

Journal Article Ahead of print

PubMed: 41589697 DOI: 10.14309/ajg.0000000000003934

MELD-Lactate and lactate clearance in critically ill cirrhosis patients with sepsis.

Am J Gastroenterol

Authors: Rehma Shabbir, Luis Garrido-Trevino, Jacqueline G O'Leary, Ashok Chaudhary, Rakhi Maiwall, Vinod Arora, Harshvardhan V Tevethia, Shiv K Sarin, Lauren Hall, Gerald O Ogola, Patrick S Kamath, Sumeet K Asrani

Affiliations

  • Baylor Scott & White Research Institute, Dallas, Texas, United States.
  • Department of Gastroenterology & Hepatology, Dallas VA Medical Center, Dallas, Texas, United States.
  • Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
  • Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
  • Baylor University Medical Center, Baylor Scott and White, Dallas, Texas, United States.

Abstract

OBJECTIVES

MELD-lactate (MELD-LA) score is an independent predictor of inpatient mortality and organ failure validated in over 8,600 patients across diverse settings. However, its utility in sepsis, particularly when combined with lactate clearance (LA clearance), has not been fully evaluated. In this study, we examined the dynamic role of MELD-LA with 24-hour LA clearance as a predictor of 30-day mortality in critically ill patients with cirrhosis and sepsis.

METHODS

We analyzed cirrhosis patients with sepsis admitted to the ICU in a large U.S. healthcare system (20 hospitals) from 2014-2022, examining MELD-LA and LA clearance within 24 hours as predictors of 30-day mortality. We externally validated our findings in the APASL-ACLF Research Consortium, a multinational Asian cohort (31 centers) from 2009-2019.

RESULTS

A total of 3,879 cirrhosis patients with sepsis were admitted to the ICU (43.2% female, 20.5% Hispanic, 12.4% on dialysis; mean initial LA 4.5 mmol/L, MELD 20.8, MELD-LA 17.6). Survivors showed a median lactate change of -1.04 (35% clearance) compared to -0.4 (12%) for non-survivors. LA clearance within 24 hours was influenced by the presenting MELD-LA. In the North American cohort, ≥35% LA clearance was associated with improved 30-day survival (OR 0.41, 95% CI 0.31-0.53; p<0.001). Similarly, in the APASL cohort (n=1,259), ≥35% clearance was linked to a 60% reduction in mortality (OR 0.42, 95% CI 0.28-0.62; p<0.001). When stratified by LA clearance, patients with LA clearance of ≥35% had a higher percentage of early administration of resuscitative measures than those with LA clearance of < 10% especially with regards to early antibiotic administration (82.5% vs 67.6%; p-value <0.001).

CONCLUSION

Early reduction in initial LA by one-third predicts 30-day mortality and may indicate treatment response in cirrhosis patients with sepsis in the ICU. Combining MELD-LA and LA clearance early enables better risk stratification and informs management.

MeSH

Mortality, Gastroenterology, Sepsis, Critical Illness