Analysis of serum lactate level in septic shock at Emergency Department of Patan Hospital, Nepal

Abstract

Background: Sepsis is a leading cause of death in emergency department. Serum lactate level assessment can play an important role for risk assessment and prognostication in critically ill septic patient. Objective: The objective of this study is to determine the relevance of initial serum lactate measurement after the implementation of sepsis protocol in emergency department, based on guidelines of Surviving Sepsis Campaign. Methods: This was a cross sectional descriptive study conducted at Patan Hospital from January 2014 to January 2015 among 94 sample of serum lactate who had clinical suspicion of sepsis as per established sepsis emergency department protocol. Data of serum lactate sent from emergency department was noted from the registry book of department of biochemistry, Patan Academy of Health Sciences. Based on clinical practice the obtained lactate results were stratifi ed intothreerisk groups: high (> 4 mmol/L), intermediate (2.5 to 3.99 mmol/L) and low (< 2.5 mmol/L). Result: Out of the total 94 samples, 56 (59.6%) were male and 38 (40.4%) were female. Mean lactate level in males was 5.73 mmol/L and that in females was 5.47 mmol/L. Abnormal lactate level was predominantly high 85 (80%) out of which 31 (29%) had intermediate whereas more than half 54 (50.76%) had high lactate level. Conclusion: This study tells that clinically diagnosed sepsis do have higher serum lactate level. So, in our context, this needs to be explored to be used for early diagnosis of sepsis.

Mean Serum Lactate Levels in Patients with Sepsis Presenting to the Department of Emergency Medicine of a Tertiary Care Center: A Descriptive Cross-sectional Study

“…A similar study was done in Patan Hospital in a total of 94 patients which showed abnormal Lactate levels in 80% among which 29% had intermediate lactate levels and half of them had high lactate levels which were unlike our findings which showed that 28.3% had intermediate and 18.9% had high lactate level. 6 On comparing the normal and abnormal lactate levels according to gender, the above study showed that among total females, 13.1% have normal lactate levels and 86.9% have abnormal while in males, 7.1% have normal lactate levels and 92.9% have abnormal, 6 unlike our study which showed that 56.5% of females have normal lactate level with 43.5 having abnormal and for males, the percentage is equally divided into halves.…”

“…A study revealed a result similar to our study which showed that the maximum number of patients (49.9 %) had low lactate levels, with ours being 52.8%. 6 However, contrary to this, another study shared that the maximum patient has intermediate lactate levels (45.3%). 7 Shock index (SI), is a simple and effective bedside assessment means of gauging the degree of shock and is as defined as heart rate divided by systolic blood pressure (SBP) with a normal range of 0.5 to 0.7 in healthy adults.…”

“…A study revealed a result similar to our study which showed that the maximum number of patients (49.9 %) had low lactate levels, with ours being 52.8%. 6 However, contrary to this, another study shared that the maximum patient has intermediate lactate levels (45.3%). 7 …”