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Prognostic significance of lactate clearance in severe acute pancreatitis

Year 2025, Volume: 50 Issue: 2, 450 - 459, 30.06.2025

Betül Çiğdem Yortanlı , Korhan Kollu , Burcu Kuş , Ekrem Taha Sert , Mehmet Yortanlı

https://doi.org/10.17826/cumj.1639534

Abstract

Purpose: This study aimed to evaluate the prognostic value of lactate clearance in predicting severe acute pancreatitis (SAP) in patients with acute pancreatitis (AP). Identifying early biomarkers for SAP can help in risk stratification and guide clinical management.
Materials and Methods: This retrospective, single-center observational study included 183 patients diagnosed with AP between January 2022 and January 2023. Patients were classified as SAP or non-SAP based on the 2012 Atlanta Classification. Demographic data, laboratory parameters, and clinical outcomes were analyzed. Lactate clearance was calculated as [(initial lactate – 24-hour lactate)/initial lactate] × 100..
Results: Among 183 patients, 105 (57.4%) had SAP. SAP patients had significantly longer hospital stays, higher intensive care unit admissions, and increased mortality rates). SAP patients had significantly higher initial and 24-hour lactate levels but lower lactate clearance. Lower lactate clearance was an independent predictor of SAP (OR: 3.051, 95% CI: 2.030–5.072, p<0.001). ROC analysis revealed that lactate clearance had an AUC of 0.835 (95% CI: 0.776–0.894), with 81.9% sensitivity and 76.9% specificity at a cutoff value of 40.9%.
Conclusion: Low lactate clearance is strongly associated with SAP development, longer hospitalization, ICU need, and increased mortality. Lactate clearance may serve as a valuable early prognostic marker. Future studies should explore integrating lactate clearance with markers such as SII, SII/albumin ratio, and RDW to enhance risk stratification and clinical decision-making in AP.

Keywords

Acute pancreatitis Lactate clearance Prognostic biomarker

References

  • Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: A review. JAMA. 2021;325:382–90.
  • Roberts SE, Morrison-Rees S, John A, Williams JG, Brown TH, Samuel DG. The incidence and aetiology of acute pancreatitis across Europe. Pancreatology. 2017;17:155–65.
  • He SS, Li D, He QY, Chen XP, Lin YX, Yu YW, et al. Establishment of early multi-indicator prediction models of moderately severe acute pancreatitis and severe acute pancreatitis. Gastroenterol Res Pract. 2022;2022:5142473.
  • Valverde-López F, Matas-Cobos AM, Alegría-Motte C, Jiménez-Rosales R, Úbeda-Muñoz M, Redondo-Cerezo E. BISAP, Ranson, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort. J Gastroenterol Hepatol. 2017;32:1649–56.
  • Chen SY, Song XJ, Lu JT, Liang JX, Ouyang H, Zheng WH et al. Application of alkaline phosphatase-to-hemoglobin and lactate dehydrogenase-to-hemoglobin ratios as novel noninvasive indices for predicting severe acute pancreatitis in patients. PloS One. 2024;19:e0312181.
  • Yao S, Chai H, Tao T, Zhang L, Yang X, Li X et al. Role of lactate and lactate metabolism in liver diseases (Review). Int J Mol Med. 2024;54:59.
  • Wang GJ, Gao CF, Wei D, Wang C, Ding SQ. Acute pancreatitis: etiology and common pathogenesis. World J Gastroenterol. 2009;15:1427–30.
  • Doganay F, Ak R, Yilmaz E. Predictive performance of lactate as a mortality predictor in patients with acute pancreatitis. J Coll Physicians Surg Pak. 2022;32:440–4.
  • Liu Q, Zheng HL, Wu MM, Wang QZ, Yan SJ, Wang M et al. Association between lactate-to-albumin ratio and 28-days all-cause mortality in patients with acute pancreatitis: A retrospective analysis of the MIMIC-IV database. Front Immunol. 2022;13:1076121.
  • Zeng Z, Huang R, Lin H, Peng H, Luo J, Ding N. Serum lactate is an indicator for short-term and long-term mortality in patients with acute pancreatitis. Dig Dis Sci. 2024;69:2223–34.
  • Zhang T, Huang X, Feng S, Shao H. Lactate-Dependent HIF1A Transcriptional Activation Exacerbates Severe Acute Pancreatitis Through the ACSL4/LPCAT3/ALOX15 Pathway Induced Ferroptosis. J Cell Biochem. 2025;126:e30687.
  • Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis*. Crit Care Med. 2014;42:2118–25.
  • Zeng J, Wan J, He W, Zhu Y, Zeng H, Liu P, et al. Prognostic value of arterial lactate metabolic clearance rate in moderate and severe acute pancreatitis. Dis Markers. 2022;2022:9233199.
  • Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.
  • Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.
  • Susur O, Yesіlaras M, Eyler Y. The relationship between lactate and lactate clearance with ın-hospital mortality in unselected emergency department patients. Prehospital Disaster Med. 2024;39:178–83.
  • Sert ZS, Bertizlioğlu M. Predictive value of the HALP score for pre-eclampsia with severe features. Postgrad Med. 2024;136:468-73.
  • Mühling T, Rohrbach H, Schepp W, Gundling F. Overlap of concurrent extrahepatic autoimmune diseases is associated with milder disease severity of newly diagnosed autoimmune hepatitis. Hepatobiliary Pancreat Dis Int. 2021;20:21–7.
  • Ak C, Kahraman R, Sayar S, Kilic ET, Adali G, Ozdil K. Prediction of prognosis acute pancreatitis with ınflammatory markers and patient characteristics compared to the scoring system: real-life data. Sisli Etfal Hastan Tip Bul. 2023;57:182–8.
  • Karabuga B, Gemcioglu E, Konca Karabuga E, Baser S, Ersoy O. Comparison of the predictive values of CRP, CRP/albumin, RDW, neutrophil/lymphocyte, and platelet/lymphocyte levels in determining the severity of acute pancreatitis in patients with acute pancreatitis according to the BISAP score. Bratisl Lek Listy. 2022;123:129–35.
  • Jagodić Ejubović A, Ejubović M, Jahić R, Brkovic A, Letic E, Vujnic M, et al. The role of red cell distribution width (rdw), rdw/platelet ratio, and mean platelet volume as prognostic markers in acute pancreatitis severity and complications based on the bedside ındex for severity in acute pancreatitis score. Cureus. 2024;16:e66193.
  • Kong W, He Y, Bao H, Zhang W, Wang X. Diagnostic value of neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis: a meta-analysis. Dis Markers. 2020;2020:9731854.
  • Vo HH, Truong-Thi NN, Ho-Thi HB, Vo HMC, Tran-Thi KT, Nguyen MD. The value of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, red cell distribution width, and their combination in predicting acute pancreatitis severity. Eur Rev Med Pharmacol Sci. 2023;27:11464–71.
  • Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Medicine (Baltimore). 2019;98:e15275.
  • Balas Ş, Çınkıl NC, Apaydın M. Şiddetli pankreatiti öngörmede yeni biyobelirteç; Sistemik immün-inflamasyon indeksi. Turk J Clin Lab. 2023;14:464–9.
  • Liu X, Guan G, Cui X, Liu Y, Liu Y, Luo F. Systemic immune-inflammation index (SII) can be an early indicator for predicting the severity of acute pancreatitis: a retrospective study. Int J Gen Med. 2021;14:9483–9.
  • Yan L, Kang P, Cao C, Jinhui B, Yong L. Prognostic value of systemic immune-inflammation index/albumin ratio for immunotherapy-treated patients receiving opioids. PloS One. 2024;19:e0305119.
  • Chauhan R, Saxena N, Kapur N, Kardam D. Comparison of modified Glasgow-Imrie, Ranson, and Apache II scoring systems in predicting the severity of acute pancreatitis. Pol Przegl Chir. 2022;95:6–12.
  • Gao W, Yang HX, Ma CE. The Value of BISAP score for predicting mortality and severity in acute pancreatitis: a systematic review and meta-analysis. PloS One. 2015;10:e0130412.
  • Zhu J, Wu L, Wang Y, Fang M, Liu Q, Zhang X. Predictive value of the Ranson and BISAP scoring systems for the severity and prognosis of acute pancreatitis: A systematic review and meta-analysis. PloS One. 2024;19:e0302046.
  • Zhou BC, Zhang Z, Zhu JJ, Liu LJ, Liu CF. Blood lactate or lactate clearance: which is robust to predict the neurological outcomes after cardiac arrest? a systematic review and meta-analysis. BioMed Res Int. 2018;2018:8014213.
  • Düring J, Dankiewicz J, Cronberg T, Hassager C, Hovdenes J, Kjaergaard J, et al. Lactate, lactate clearance and outcome after cardiac arrest: A post-hoc analysis of the TTM-Trial. Acta Anaesthesiol Scand. 2018;62:1436–42.
  • Emhoff CAW, Messonnier LA. Concepts of lactate metabolic clearance rate and lactate clamp for metabolic inquiry: a mini-review. Nutrients. 2023;15:3213.

Şiddetli akut pankreatitte laktat klirensinin prognostik önemi

Year 2025, Volume: 50 Issue: 2, 450 - 459, 30.06.2025

Betül Çiğdem Yortanlı , Korhan Kollu , Burcu Kuş , Ekrem Taha Sert , Mehmet Yortanlı

https://doi.org/10.17826/cumj.1639534

Abstract

Amaç: Bu çalışma, akut pankreatit (AP) hastalarında laktat klirensinin şiddetli akut pankreatit (SAP) gelişimini öngörmedeki prognostik değerini değerlendirmeyi amaçlamaktadır. SAP için erken dönemde belirteçlerin tanımlanması, risk sınıflandırmasını kolaylaştırarak klinik yönetimi yönlendirebilir.
Gereç ve Yöntem: Bu retrospektif, tek merkezli gözlemsel çalışma, Ocak 2022 ile Ocak 2023 tarihleri arasında AP tanısı alan 183 hastayı içermektedir. Hastalar, 2012 Atlanta Klasifikasyonu’na göre SAP ve non-SAP gruplarına ayrıldı. Demografik veriler, laboratuvar parametreleri ve klinik sonuçlar analiz edildi. Laktat klirensi [(ilk laktat – 24. saat laktat) / ilk laktat] × 100 formülü ile hesaplandı.
Bulgular: Toplam 183 hastanın 105’i (%57.4) SAP grubundaydı. SAP hastalarında hastane yatış süresi, yoğun bakım gereksinimi ve mortalite oranları anlamlı olarak daha yüksekti. SAP hastalarında başlangıç ve 24. saat laktat seviyeleri daha yüksekti, ancak laktat klirensi anlamlı şekilde daha düşüktü. Laktat klirensi, SAP için bağımsız bir belirleyici olarak bulundu (OO = 3.051, %95 CI: 2.030-5.072, p<0.001). ROC analizi, laktat klirensinin %40,9'luk bir kesme değerinde %81,9 duyarlılık ve %76,9 özgüllük ile 0,835'lik (%95 GA: 0,776-0,894) bir AUC sahip olduğunu ortaya koymuştur.
Sonuç: Düşük laktat klirensi SAP gelişimi, daha uzun süre hastanede kalma, YBÜ ihtiyacı ve artmış mortalite ile güçlü bir şekilde ilişkilidir. Laktat klirensi değerli bir erken prognostik belirteç olarak hizmet edebilir. Gelecekteki çalışmalar, AP'de risk sınıflandırmasını ve klinik karar verme sürecini geliştirmek için laktat klirensini SII, SII/albümin oranı ve RDW gibi belirteçlerle entegre etmeyi araştırmalıdır.

Keywords

Akut pankreatit Laktat klirensi Prognostik biyobelirteç

References

  • Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: A review. JAMA. 2021;325:382–90.
  • Roberts SE, Morrison-Rees S, John A, Williams JG, Brown TH, Samuel DG. The incidence and aetiology of acute pancreatitis across Europe. Pancreatology. 2017;17:155–65.
  • He SS, Li D, He QY, Chen XP, Lin YX, Yu YW, et al. Establishment of early multi-indicator prediction models of moderately severe acute pancreatitis and severe acute pancreatitis. Gastroenterol Res Pract. 2022;2022:5142473.
  • Valverde-López F, Matas-Cobos AM, Alegría-Motte C, Jiménez-Rosales R, Úbeda-Muñoz M, Redondo-Cerezo E. BISAP, Ranson, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort. J Gastroenterol Hepatol. 2017;32:1649–56.
  • Chen SY, Song XJ, Lu JT, Liang JX, Ouyang H, Zheng WH et al. Application of alkaline phosphatase-to-hemoglobin and lactate dehydrogenase-to-hemoglobin ratios as novel noninvasive indices for predicting severe acute pancreatitis in patients. PloS One. 2024;19:e0312181.
  • Yao S, Chai H, Tao T, Zhang L, Yang X, Li X et al. Role of lactate and lactate metabolism in liver diseases (Review). Int J Mol Med. 2024;54:59.
  • Wang GJ, Gao CF, Wei D, Wang C, Ding SQ. Acute pancreatitis: etiology and common pathogenesis. World J Gastroenterol. 2009;15:1427–30.
  • Doganay F, Ak R, Yilmaz E. Predictive performance of lactate as a mortality predictor in patients with acute pancreatitis. J Coll Physicians Surg Pak. 2022;32:440–4.
  • Liu Q, Zheng HL, Wu MM, Wang QZ, Yan SJ, Wang M et al. Association between lactate-to-albumin ratio and 28-days all-cause mortality in patients with acute pancreatitis: A retrospective analysis of the MIMIC-IV database. Front Immunol. 2022;13:1076121.
  • Zeng Z, Huang R, Lin H, Peng H, Luo J, Ding N. Serum lactate is an indicator for short-term and long-term mortality in patients with acute pancreatitis. Dig Dis Sci. 2024;69:2223–34.
  • Zhang T, Huang X, Feng S, Shao H. Lactate-Dependent HIF1A Transcriptional Activation Exacerbates Severe Acute Pancreatitis Through the ACSL4/LPCAT3/ALOX15 Pathway Induced Ferroptosis. J Cell Biochem. 2025;126:e30687.
  • Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis*. Crit Care Med. 2014;42:2118–25.
  • Zeng J, Wan J, He W, Zhu Y, Zeng H, Liu P, et al. Prognostic value of arterial lactate metabolic clearance rate in moderate and severe acute pancreatitis. Dis Markers. 2022;2022:9233199.
  • Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.
  • Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.
  • Susur O, Yesіlaras M, Eyler Y. The relationship between lactate and lactate clearance with ın-hospital mortality in unselected emergency department patients. Prehospital Disaster Med. 2024;39:178–83.
  • Sert ZS, Bertizlioğlu M. Predictive value of the HALP score for pre-eclampsia with severe features. Postgrad Med. 2024;136:468-73.
  • Mühling T, Rohrbach H, Schepp W, Gundling F. Overlap of concurrent extrahepatic autoimmune diseases is associated with milder disease severity of newly diagnosed autoimmune hepatitis. Hepatobiliary Pancreat Dis Int. 2021;20:21–7.
  • Ak C, Kahraman R, Sayar S, Kilic ET, Adali G, Ozdil K. Prediction of prognosis acute pancreatitis with ınflammatory markers and patient characteristics compared to the scoring system: real-life data. Sisli Etfal Hastan Tip Bul. 2023;57:182–8.
  • Karabuga B, Gemcioglu E, Konca Karabuga E, Baser S, Ersoy O. Comparison of the predictive values of CRP, CRP/albumin, RDW, neutrophil/lymphocyte, and platelet/lymphocyte levels in determining the severity of acute pancreatitis in patients with acute pancreatitis according to the BISAP score. Bratisl Lek Listy. 2022;123:129–35.
  • Jagodić Ejubović A, Ejubović M, Jahić R, Brkovic A, Letic E, Vujnic M, et al. The role of red cell distribution width (rdw), rdw/platelet ratio, and mean platelet volume as prognostic markers in acute pancreatitis severity and complications based on the bedside ındex for severity in acute pancreatitis score. Cureus. 2024;16:e66193.
  • Kong W, He Y, Bao H, Zhang W, Wang X. Diagnostic value of neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis: a meta-analysis. Dis Markers. 2020;2020:9731854.
  • Vo HH, Truong-Thi NN, Ho-Thi HB, Vo HMC, Tran-Thi KT, Nguyen MD. The value of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, red cell distribution width, and their combination in predicting acute pancreatitis severity. Eur Rev Med Pharmacol Sci. 2023;27:11464–71.
  • Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Medicine (Baltimore). 2019;98:e15275.
  • Balas Ş, Çınkıl NC, Apaydın M. Şiddetli pankreatiti öngörmede yeni biyobelirteç; Sistemik immün-inflamasyon indeksi. Turk J Clin Lab. 2023;14:464–9.
  • Liu X, Guan G, Cui X, Liu Y, Liu Y, Luo F. Systemic immune-inflammation index (SII) can be an early indicator for predicting the severity of acute pancreatitis: a retrospective study. Int J Gen Med. 2021;14:9483–9.
  • Yan L, Kang P, Cao C, Jinhui B, Yong L. Prognostic value of systemic immune-inflammation index/albumin ratio for immunotherapy-treated patients receiving opioids. PloS One. 2024;19:e0305119.
  • Chauhan R, Saxena N, Kapur N, Kardam D. Comparison of modified Glasgow-Imrie, Ranson, and Apache II scoring systems in predicting the severity of acute pancreatitis. Pol Przegl Chir. 2022;95:6–12.
  • Gao W, Yang HX, Ma CE. The Value of BISAP score for predicting mortality and severity in acute pancreatitis: a systematic review and meta-analysis. PloS One. 2015;10:e0130412.
  • Zhu J, Wu L, Wang Y, Fang M, Liu Q, Zhang X. Predictive value of the Ranson and BISAP scoring systems for the severity and prognosis of acute pancreatitis: A systematic review and meta-analysis. PloS One. 2024;19:e0302046.
  • Zhou BC, Zhang Z, Zhu JJ, Liu LJ, Liu CF. Blood lactate or lactate clearance: which is robust to predict the neurological outcomes after cardiac arrest? a systematic review and meta-analysis. BioMed Res Int. 2018;2018:8014213.
  • Düring J, Dankiewicz J, Cronberg T, Hassager C, Hovdenes J, Kjaergaard J, et al. Lactate, lactate clearance and outcome after cardiac arrest: A post-hoc analysis of the TTM-Trial. Acta Anaesthesiol Scand. 2018;62:1436–42.
  • Emhoff CAW, Messonnier LA. Concepts of lactate metabolic clearance rate and lactate clamp for metabolic inquiry: a mini-review. Nutrients. 2023;15:3213.
There are 33 citations in total.

Details

Primary Language English
Subjects Gastroenterology and Hepatology, ​Internal Diseases, Intensive Care
Journal Section Research
Authors

Betül Çiğdem Yortanlı 0000-0003-2698-3159

Korhan Kollu 0000-0002-0973-724X

Burcu Kuş 0000-0002-9283-8016

Ekrem Taha Sert 0000-0002-7208-2186

Mehmet Yortanlı 0000-0002-6744-2423

Publication Date June 30, 2025
Submission Date February 14, 2025
Acceptance Date May 23, 2025
Published in Issue Year 2025 Volume: 50 Issue: 2

Cite

MLA Yortanlı, Betül Çiğdem et al. “Prognostic Significance of Lactate Clearance in Severe Acute Pancreatitis”. Cukurova Medical Journal, vol. 50, no. 2, 2025, pp. 450-9, doi:10.17826/cumj.1639534.
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