Bruno Levy1,2, Pierre Perez3, Sebastien Gibot4,5, Alain Gerard3. 1. Groupe Choc, Contrat AVENIR INSERM, Faculté de Médecine, Nancy Université, Vandoeuvre les Nancy Cedex, France. b.levy@chu-nancy.fr. 2. Services de Réanimation Médicale, CHU Nancy-Brabois, Nancy and Vandoeuvre les Nancy, Tour Drouet 6, 54511, Vandoeuvre les Nancy Cedex, France. b.levy@chu-nancy.fr. 3. Services de Réanimation Médicale, CHU Nancy-Brabois, Nancy and Vandoeuvre les Nancy, Tour Drouet 6, 54511, Vandoeuvre les Nancy Cedex, France. 4. Groupe Choc, Contrat AVENIR INSERM, Faculté de Médecine, Nancy Université, Vandoeuvre les Nancy Cedex, France. 5. Services de Réanimation Médicale, Hôpital Central, Nancy and Vandoeuvre les Nancy, Vandoeuvre les Nancy Cedex, France.
Abstract
PURPOSE: During septic shock, muscle produces lactate and pyruvate by way of an exaggerated Na(+), K(+)-ATPase-stimulated aerobic glycolysis associated with epinephrine stimulation. We hypothesized that patients with sepsis without shock and increased epinephrine levels or an increased muscle-to-serum lactate gradient are likely to evolve towards septic shock. Thus, in sepsis patients, we investigated (1) whether muscle produces lactate and pyruvate, and (2) whether muscle lactate production is linked to epinephrine levels and the severity of the patient's condition. METHODS: We studied 40 ventilated patients with sepsis without shock or hyperlactatemia and a control group of 10 ICU patients without infection. A microdialysis probe was inserted into the quadriceps muscle. Plasma lactate and pyruvate concentrations were measured in both the dialysate fluid and arterial blood samples every 6 h. RESULTS: There was no gradient between muscle and arterial levels for lactate and pyruvate in the control group. In the sepsis group, muscle lactate and pyruvate concentrations were consistently higher than the arterial levels (P < 0.01). Plasma epinephrine concentrations were also elevated (P < 0.05). A total of 15/40 patients further developed septic shock, and on admission these patients had significantly higher musculo-arterial gradients of lactate (2.9 ± 0.3 vs. 0.7 ± 0.2 mmol/l) (P < 0.05) and pyruvate (740 ± 60 vs. 200 ± 20 μmol/l) (P < 0.05), and higher levels of epinephrine concentrations (6.2 ± 0.7 vs. 2.5 ± 0.24 nmol/l) (P < 0.05). Both the lactate gradient and epinephrine concentrations measured on admission were good predictors of the evolution towards septic shock. CONCLUSIONS: Muscle produces lactate and pyruvate during sepsis, and this production is highly correlated with plasma epinephrine secretion and severity of illness.
PURPOSE: During septic shock, muscle produces lactate and pyruvate by way of an exaggerated Na(+), K(+)-ATPase-stimulated aerobic glycolysis associated with epinephrine stimulation. We hypothesized that patients with sepsis without shock and increased epinephrine levels or an increased muscle-to-serum lactate gradient are likely to evolve towards septic shock. Thus, in sepsis patients, we investigated (1) whether muscle produces lactate and pyruvate, and (2) whether muscle lactate production is linked to epinephrine levels and the severity of the patient's condition. METHODS: We studied 40 ventilated patients with sepsis without shock or hyperlactatemia and a control group of 10 ICU patients without infection. A microdialysis probe was inserted into the quadriceps muscle. Plasma lactate and pyruvate concentrations were measured in both the dialysate fluid and arterial blood samples every 6 h. RESULTS: There was no gradient between muscle and arterial levels for lactate and pyruvate in the control group. In the sepsis group, muscle lactate and pyruvate concentrations were consistently higher than the arterial levels (P < 0.01). Plasma epinephrine concentrations were also elevated (P < 0.05). A total of 15/40 patients further developed septic shock, and on admission these patients had significantly higher musculo-arterial gradients of lactate (2.9 ± 0.3 vs. 0.7 ± 0.2 mmol/l) (P < 0.05) and pyruvate (740 ± 60 vs. 200 ± 20 μmol/l) (P < 0.05), and higher levels of epinephrine concentrations (6.2 ± 0.7 vs. 2.5 ± 0.24 nmol/l) (P < 0.05). Both the lactate gradient and epinephrine concentrations measured on admission were good predictors of the evolution towards septic shock. CONCLUSIONS: Muscle produces lactate and pyruvate during sepsis, and this production is highly correlated with plasma epinephrine secretion and severity of illness.
Authors: J H James; K R Wagner; J K King; R E Leffler; R K Upputuri; A Balasubramaniam; L A Friend; D A Shelly; R J Paul; J E Fischer Journal: Am J Physiol Date: 1999-07
Authors: Sara Singhal; Mathias W Allen; John-Ryan McAnnally; Kenneth S Smith; John P Donnelly; Henry E Wang Journal: PeerJ Date: 2013-05-21 Impact factor: 2.984
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; Herwig Gerlach; Goran Hedenstierna; Michael Joannidis; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Jean-Charles Preiser; Jerôme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2011-01-04 Impact factor: 17.440
Authors: Glenn Hernandez; Tomas Regueira; Alejandro Bruhn; Ricardo Castro; Maximiliano Rovegno; Andrea Fuentealba; Enrique Veas; Dolores Berrutti; Jorge Florez; Eduardo Kattan; Celeste Martin; Can Ince Journal: Ann Intensive Care Date: 2012-10-15 Impact factor: 6.925