Effect of alcohol on the lactate/pyruvate ratio of recently injured adults

Crit Care Med. 2002 May;30(5):981-5. doi: 10.1097/00003246-200205000-00005.


Objective: To compare the ability of plasma (lactate) and the plasma lactate/pyruvate (L/P) ratio to predict shock-related outcome after injury and also to examine the influence of plasma ethanol on any relationships found.

Design: Prospective observational study.

Setting: Emergency departments in the UK and the Republic of South Africa.

Patients: Blood samples were taken at presentation from 232 adult patients 1-23 hrs (median, 3.5 hrs) after sustaining an injury or injuries deemed sufficiently severe to require inpatient care.

Measurements: Plasma concentrations of lactate, pyruvate, and ethanol, anatomical severity of injury, development of multiple organ failure, and 30-day survival were determined.

Results: At 90% specificity for predicting subsequent mortality and/or multiple organ failure, plasma lactate >or=3.85 mmol/L was 23% (5% to 41%) more sensitive than an L/P ratio of >or=42.76. At 90% sensitivity for ruling out morbidity, plasma lactate <1.6 mmol/L is 6% (-1% to 13%) more specific than an L/P ratio of <14.08. High L/P ratios were noted to be associated with a detectable plasma alcohol level. A post hoc regression analysis showed that alcohol-positive/-negative status was a much stronger predictor of the L/P ratio than was anatomical severity of injury, shock, or time after injury.

Conclusions: Plasma lactate alone is a better predictor than the L/P ratio of shock-related outcome after injury. The interpretation of L/P ratios after injury is confounded in the presence of elevated plasma ethanol.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Ethanol / blood
  • Ethanol / pharmacology*
  • Female
  • Humans
  • Lactates / blood*
  • Male
  • Middle Aged
  • Prospective Studies
  • Pyruvates / blood*
  • Sensitivity and Specificity
  • Time Factors
  • Wounds and Injuries / blood*
  • Wounds and Injuries / mortality


  • Biomarkers
  • Lactates
  • Pyruvates
  • Ethanol