The correlation of blood thiamine concentrations with lactate acidosis in peritonitis patients with sepsis

Maria Meilita Sinaga; Vicky Sumarki Budipramana; Jusak Nugraha

doi:10.15562/bmj.v10i1.2237

The correlation of blood thiamine concentrations with lactate acidosis in peritonitis patients with sepsis

Maria Meilita Sinaga ,

Vicky Sumarki Budipramana ,

Jusak Nugraha ,

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DOI: https://doi.org/10.15562/bmj.v10i1.2237 |
Published: 2021-04-28

Abstract

Background: Vitamin B1 (Thiamine) functions as a pyruvate dehydrogenase cofactor to produce acetyl Co-A and activate the Krebs cycle in cellular metabolism. The hypermetabolic state in septic condition requires excess thiamin to keep the Krebs cycle functioning well. The thiamin level in the blood decreases and causes mitochondrial dysfunction and vice versa results in an increase in lactate levels. This study aims to evaluate the correlation of blood thiamine concentrations with lactate acidosis in peritonitis patients with sepsis

Methods: Prospective observational study in 65 adult septic patients who came to the hospital with peritonitis and underwent laparotomy. Thiamine concentration was assessed on days 1, 3, and 5 by liquid chromatography-mass spectrometry (LC-MS). The primary outcome was lactate levels. Data was analyzed using SPSS version 23 for Windows.

Results: The incidence of thiamine deficiency (TD) was 61.5% of patients. Specifically, 29 cases (44.6%) had absolute thiamine deficiency (TD) on presentation, 4 patients (6.1%) developed it on day 3, and another 7 patients (10.8%) on day 5. Thiamine was negatively correlated with lactate levels (r=-0.600; p=0.020). The relationship appeared after multivariable regression analysis controlling for sex, septic shock, and malnutrition. Overall, for the TD group, there was a significant association with septic shock, malnourishment, and Mortality (p<0.05).

Conclusion: Thiamine deficiency had significantly raised lactate levels, which might increase the risk of Mortality.

References

Sartelli M, Catena F, Di Saverio S, Ansaloni L, Malangoni M, Moore EE, et al. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg. 2014;9(1):1-16.
Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014;311(13):1308-1316.
Garcia-Alvarez M, Marik P, Bellomo R. Sepsis-associated hyperlactatemia. Crit Care. 2014;18(5):1-11.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017 Mar;43(3):304-377.
Leite HP, de Lima LFP, Taddei JAAC, Paes Ã‚T. Effect of blood thiamine concentrations on mortality: Influence of nutritional status. Nutrition. 2018;48:105-110.
Manzanares W, Hardy G. Thiamine supplementation in the critically ill. Curr Opin Clin Nutr Metab Care. 2011;14(6):610-617.
Cruickshank AM, Telfer AB, Shenkin A. Thiamine deficiency in the critically ill. Intensive Care Med. 1988;14(4):384-387.
Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009;28(4):387-400.
Donnino MW, Carney E, Cocchi MN, Barbash I, Chase M, Joyce N, et al. Thiamine deficiency in critically ill patients with sepsis. J Crit Care. 2010;25(4):576-81.
Moskowitz A, Andersen LW, Huang DT, Berg KM, Grossestreuer AV, Marik PE, et al. Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation. Crit Care. 2018;22(1):1-7.
Crook MA, Sriram K. Thiamine deficiency: the importance of recognition and prompt management. Nutrition. 2014;30(7-8):953-954.
Attaluri P, Castillo A, Edriss H, Nugent K. Thiamine Deficiency: An Important Consideration in Critically Ill Patients. Am J Med Sci. 2018;356(4):382-390.
Huckabee WE. Abnormal resting blood lactate. I. The significance of hyperlactatemia in hospitalized patients. Am J Med. 1961;30:840-848.
Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970;41(6):989-1001.
Boekstegers P, WeidenhÃ¶fer S, Kapsner T, Werdan K. Skeletal muscle partial pressure of oxygen in patients with sepsis. Crit Care Med. 1994;22(4):640-650.
Donnino MW, Andersen LW, Chase M, Berg KM, Tidswell M, Giberson T, et al. Randomized, Double-Blind, Placebo-Controlled Trial of Thiamine as a Metabolic Resuscitator in Septic Shock: A Pilot Study. Crit Care Med. 2016;44(2):360-7.
Dharma BDA, Mulyantari NK, Prabawa IPY. Analisis korelasi kadar serum prokalsitonin dengan jumlah leukosit pada penderita dengan kecurigaan sepsis di RSUP Sanglah, Bali, Indonesia. Intisari Sains Medis. 2020;11(1):179-182.

[1] Sartelli M, Catena F, Di Saverio S, Ansaloni L, Malangoni M, Moore EE, et al. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg. 2014;9(1):1-16.

[2] Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014;311(13):1308-1316.

[3] Garcia-Alvarez M, Marik P, Bellomo R. Sepsis-associated hyperlactatemia. Crit Care. 2014;18(5):1-11.

[4] Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017 Mar;43(3):304-377.

[5] Leite HP, de Lima LFP, Taddei JAAC, Paes Ã‚T. Effect of blood thiamine concentrations on mortality: Influence of nutritional status. Nutrition. 2018;48:105-110.

[6] Manzanares W, Hardy G. Thiamine supplementation in the critically ill. Curr Opin Clin Nutr Metab Care. 2011;14(6):610-617.

[7] Cruickshank AM, Telfer AB, Shenkin A. Thiamine deficiency in the critically ill. Intensive Care Med. 1988;14(4):384-387.

[8] Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009;28(4):387-400.

[9] Donnino MW, Carney E, Cocchi MN, Barbash I, Chase M, Joyce N, et al. Thiamine deficiency in critically ill patients with sepsis. J Crit Care. 2010;25(4):576-81.

[10] Moskowitz A, Andersen LW, Huang DT, Berg KM, Grossestreuer AV, Marik PE, et al. Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation. Crit Care. 2018;22(1):1-7.

[11] Crook MA, Sriram K. Thiamine deficiency: the importance of recognition and prompt management. Nutrition. 2014;30(7-8):953-954.

[12] Attaluri P, Castillo A, Edriss H, Nugent K. Thiamine Deficiency: An Important Consideration in Critically Ill Patients. Am J Med Sci. 2018;356(4):382-390.

[13] Huckabee WE. Abnormal resting blood lactate. I. The significance of hyperlactatemia in hospitalized patients. Am J Med. 1961;30:840-848.

[14] Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970;41(6):989-1001.

[15] Boekstegers P, WeidenhÃ¶fer S, Kapsner T, Werdan K. Skeletal muscle partial pressure of oxygen in patients with sepsis. Crit Care Med. 1994;22(4):640-650.

[16] Donnino MW, Andersen LW, Chase M, Berg KM, Tidswell M, Giberson T, et al. Randomized, Double-Blind, Placebo-Controlled Trial of Thiamine as a Metabolic Resuscitator in Septic Shock: A Pilot Study. Crit Care Med. 2016;44(2):360-7.

[17] Dharma BDA, Mulyantari NK, Prabawa IPY. Analisis korelasi kadar serum prokalsitonin dengan jumlah leukosit pada penderita dengan kecurigaan sepsis di RSUP Sanglah, Bali, Indonesia. Intisari Sains Medis. 2020;11(1):179-182.

The correlation of blood thiamine concentrations with lactate acidosis in peritonitis patients with sepsis

Abstract

References

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