The Role of Lactate-based Serum Tests for Prediction of 30-day Mortality in Hospitalized Cirrhotic Patients with Acute Decompensation: A Prospective Cohort Study

Abstract

Objective: Cirrhotic patients with acute decompensation are associated with high short-term mortality. The prognostic performance of venous lactate (VLAC) for mortality prediction in these patients has not been well established. This study aimed to evaluate the role of several lactate-based serum tests for prediction of 30-day mortality in these patients. Materials and Methods: Cirrhotic patients with acute decompensation were prospectively enrolled. VLAC on admission and at 6, 12, and 24 hours were determined. Lactate clearance (LAC-Cl), MELD-lactate, and MELD-lactate clearance (MELD-ΔLA) at each timepoint were calculated and compared between 30-days survivors and non-survivors. Results: 74 patients were included (age 69±13 years, 66.2% male, MELD 18.3±7). The main indications for admission were infection (67.6%) and gastrointestinal bleeding (18.9%). The 30-day mortality rate was 29.7%. Initial VLAC was significantly higher in non-survivors (9.7±8 vs. 3.61±1.79 mmol/L, P<0.001). In addition, VLAC at 6, 12, 24 hours, MELD-Lactate and MELD-ΔLA scores were significantly higher in non-survivors. Based on ROC analysis, the VLAC, MELD-Lactate, and MELD-ΔLA at 6 hours were reliable predictors of 30-day mortality (AUROC 0.79, 0.86, and 0.86, respectively). However, compared to MELD score (AUROC 0.81), no significant difference was found. Conclusion: In hospitalized cirrhotic patient with acute decompensation, VLAC, MELD-Lactate and MELD-ΔLA at 6 hours are simple, and reliable predictors for 30-day mortality.