Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia : A retrospective cohort study according to the Sepsis-3 definitions
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc..
ABSTRACT: The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (<10%, <20%, and <30%) was evaluated. We compared the sensitivity and specificity between metrics.Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower 6-hour lactate clearance than those of survivors. Six-hour lactate levels and 6-hour lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097-1.294] and 0.989 [0.983-0.995], respectively). Six-hour lactate levels had better prognostic value than 6-hour lactate clearance (area under the curve, 0.720 [95% CI, 0.670-0.765] vs 0.656 [0.605-0.705]; P = .02). Six-hour lactate levels of ≥3.5 mmol/L and 6-hour lactate clearance of <24.4% were the optimal cut-off value in predicting the 30-day mortality. The prognostic value of 6-hour lactate metrics and 6-hour lactate clearance metrics did not differ. Six-hour lactate levels (≥2 mmol/L) had the highest sensitivity (89.2%).Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than 6-hour lactate clearance and initial lactate levels.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:100 |
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| Enthalten in: |
Medicine - 100(2021), 7 vom: 19. Feb., Seite e24835 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lee, Seong Geun [VerfasserIn] |
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| Anmerkungen: |
Date Completed 01.03.2021 Date Revised 03.01.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/MD.0000000000024835 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM321665686 |
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| 100 | 1 | |a Lee, Seong Geun |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia |b A retrospective cohort study according to the Sepsis-3 definitions |
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| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. | ||
| 520 | |a ABSTRACT: The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (<10%, <20%, and <30%) was evaluated. We compared the sensitivity and specificity between metrics.Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower 6-hour lactate clearance than those of survivors. Six-hour lactate levels and 6-hour lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097-1.294] and 0.989 [0.983-0.995], respectively). Six-hour lactate levels had better prognostic value than 6-hour lactate clearance (area under the curve, 0.720 [95% CI, 0.670-0.765] vs 0.656 [0.605-0.705]; P = .02). Six-hour lactate levels of ≥3.5 mmol/L and 6-hour lactate clearance of <24.4% were the optimal cut-off value in predicting the 30-day mortality. The prognostic value of 6-hour lactate metrics and 6-hour lactate clearance metrics did not differ. Six-hour lactate levels (≥2 mmol/L) had the highest sensitivity (89.2%).Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than 6-hour lactate clearance and initial lactate levels | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 7 | |a Lactic Acid |2 NLM | |
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| 700 | 1 | |a Song, Juhyun |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Dae Won |e verfasserin |4 aut | |
| 700 | 1 | |a Moon, Sungwoo |e verfasserin |4 aut | |
| 700 | 1 | |a Cho, Han-Jin |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Joo Yeong |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Jonghak |e verfasserin |4 aut | |
| 700 | 1 | |a Cha, Jae Hyung |e verfasserin |4 aut | |
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