Lactate metabolism in decompensated liver cirrhosis

Lactate is a metabolic product of anaerobic glycolysis that is cleared by the liver and is therefore an important diagnostic parameter in patient management. Patients with liver cirrhosis are characterised by elevated lactate levels, suggesting impaired hepatic lactate clearance.

To further analyse the hepatic lactate clearance in cirrhosis, lactate levels as well as glucose, oxygen content and pH were analysed in 25 patients in peripheral and central venous blood as well as blood collected from the hepatic, portal, mesenteric and splenic veins during transjugular intrahepatic portosystemic shunt (TIPS) procedures.

Lactate concentration in central venous blood was significantly increased in patients with Child-Pugh stage C liver cirrhosis compared with stages A and B cirrhosis. In this respect, the data indicate that the most important net lactate producers are the muscles and the gastrointestinal tract, as shown by the lactate concentrations in the peripheral venous blood and the mesenteric vein, respectively, whereas the cirrhotic liver is not a net lactate producer.

Interestingly, however, analysis of portal and hepatic vein lactate concentrations suggested that the metabolic capacity and consequent lactate clearance was not affected by the stage of liver cirrhosis. Instead, the transient increase in lactate concentration after initiation of TIPS could be explained, at least in part, by transiently impaired clearance by direct shunting of blood from the mesenteric vein through the intrahepatic stent.

In conclusion, elevated lactate levels in patients with cirrhosis are more likely to be due to microcirculatory disturbances and consequent increased anaerobic glycolysis than to decreased clearance.

Publication History

Article published online:
23 January 2024