Blood lactate concentration in COVID-19: a systematic literature review
Open accessAbstract
Coronavirus disease 2019 (COVID-19) is an infectious respiratory condition sustained by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which manifests prevalently as mild to moderate respiratory tract infection. Nevertheless, in a number of cases the clinical course may deteriorate, with onset of end organ injury, systemic dysfunction, thrombosis and ischemia. Given the clinical picture, baseline assessment and serial monitoring of blood lactate concentration may be conceivably useful in COVID-19. We hence performed a systematic literature review to explore the possible association between increased blood lactate levels, disease severity and mortality in COVID-19 patients, including comparison of lactate values between COVID-19 and non-COVID-19 patients. We carried out an electronic search in Medline and Scopus, using the keywords “COVID-19” OR “SARS-CoV-2” AND “lactate” OR “lactic acid” OR “hyperlactatemia”, between 2019 and present time (i.e. October 10, 2021), which allowed to identify 19 studies, totalling 6,459 patients. Overall, we found that COVID-19 patients with worse outcome tend to display higher lactate values than those with better outcome, although most COVID-19 patients in the studies included in our analysis did not have sustained baseline hyperlactatemia. Substantially elevated lactate values were neither consistently present in all COVID-19 patients who developed unfavourable clinical outcomes. These findings suggest that blood lactate monitoring upon admission and throughout hospitalization may be useful for early identification of higher risk of unfavourable COVID-19 illness progression, though therapeutic decisions based on using conventional hyperlactatemia cut-off values (i.e., 2.0 mmol/L) upon first evaluation may be inappropriate in patients with SARS-CoV-2 infection.
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Interpretation of LDH results may be difficult in COVID-19 patients, as both lactate and LDH were also found to be independent risk factors of severe forms of COVID-19.
“However, interpretation of the results may be difficult in COVID-19 patients, as both lactate and LDH were also found to be independent risk factors of severe forms of COVID-19 [57,58].”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [58]
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- Authors
- Carpenè, G., Onorato, D., Nocini, R., Fortunato, G., Rizk, J. G., Henry, B. M., & Lippi, G.
- Affiliations
- University of Verona (IT)
- Arizona State University (US)
- Cincinnati Children's Hospital Medical Center (US)
- Corresponding author
- Lippi, Giuseppe
- Venue
- Clinical Chemistry and Laboratory Medicine (CCLM)
- Publisher
- Walter de Gruyter GmbH
- Published
- 2021-12-02
- Volume
- 60
- Issue
- 3
- Pages
- 332-337
- ISSN
- 1434-6621 (ISSN-L)
- 1437-4331
- OpenAlex
- W3216188313
- Cited by
- 68
- References
- 31
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 26 · 2023: 17 · 2022: 12 · 2021: 1
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Clinical Chemistry and Laboratory Medicine (CCLM) (publishedVersion)
- PubMed (publishedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Zenodo (CERN European Organization for Nuclear Research) (other-oa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- COVID-19 pandemic, SARS-CoV-2, blood lactate, hyperlactatemia, disease severity, mortality, lactate monitoring, prognostic factors, cut-off values
- MeSH terms
- COVID-19, SARS-CoV-2, Hospitalization, Humans, Lactic Acid, Hyperlactatemia
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