Ninety-minute vs 3-h performance of high-sensitivity cardiac troponin assays for predicting hospitalization for acute coronary syndrome.

Linear regression analyses identified a significant correlation of plasma D-lactate concentration with acidosis (bicarbonate, r ϭ Ϫ0.575, P Ͻ 0.001) and high anion gap (r ϭ 0.593, P Ͻ 0.001) (Fig. 1). The contribution of D-lactate to acidosis and anion gap was comparable to that of ␤-hydroxybutyrate. The contribution of D-lactate and ␤-hydroxybutyrate to the high anion gap found in DKA was statistically significant (r ϭ 0.593, P Ͻ 0.001, and r ϭ 0.642, P Ͻ 0.001, respectively). Under physiologic conditions, D-lactate is present in the human body at low concentrations (4). Blood concentrations of D-lactate are increased in diabetes, and particularly in DKA in humans (3). D-lactate is generated by degradation of methylglyoxal, an intermediate glucose metabolite, through the glyoxalase system (3, 5). High concentrations of D-lactate can induce severe metabolic acidosis, resulting in neurological symptoms and encephalopathy. In hypergly-cemic disorders such as diabetes mellitus and DKA, methylglyoxal production is greatly increased (3, 5). Consistent with our previous finding, the increased D-lactate concentration is inversely associated with bicarbonate concentration and positively correlated with the increasing anion gap. Reduction of plasma D-lactate concentrations correlated well with improvement of bicarbonate concentrations and an-ion gap following treatment. In conclusion, our findings suggest a large contribution of plasma D-lactate to the metabolic acidosis and high anion gap in DKA. Inclusion of the measurement of plasma D-lactate concentrations helps to account for the anion gap and the severity of metabolic acidosis in patients with DKA. Measurement of plasma D-lactate is important in predicting the severity of DKA as characterized by acidosis and high anion gap and monitoring DKA progression. Author Contributions: All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article. References 1. Kitabchi AE, Umpierrez GE, Murphy MB, Kreis-berg RA. Hyperglycemic crises in adult patients with diabetes: a consensus statement from thevath AR, Kirkman MS, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. and proapoptotic effects of methylglyoxal on neutrophils from patients with type 2 diabetes mellitus. In patients undergoing trans-coronary ablation for septal hyper-trophy, concentrations of high-sensitivity cardiac troponin T (hs-cTnT) 1 increase within 15 min 1 Nonstandard abbreviations: hs-cTnT; …