Blood lactate levels are better prognostic indicators than TNF and IL-6 levels in patients with septic shock

Marécaux, Gaëtan; Pinsky, Michael R.; Dupont, Étienne; Kahn, Robert J.; Vincent, Jean‐Louis

doi:10.1007/bf01712155

Cited by 103 publications

(33 citation statements)

References 37 publications

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“…Esse resultado está em concordância com outros estudos que mostraram que dosagens únicas e precoces de lactato podem ser preditivas de mortalidade [11][12][13] . Alguns autores acreditam que a persistência de valores altos de lactato no curso da doença são mais sensíveis em predizer evolução desfavorável e morte 14,15 . Os resultados do presente estudo não encontraram correlação entre níveis de lactato e disfunção orgânica avaliada pelo escore SOFA.…”

Section: Métodounclassified

“…This is similar to the results of other studies demonstrating that the early determination of lactate levels can be predictive of the mortality [11][12][13] . Some authors believe that persistent, elevated levels of lactate during the evolution of the disease are more sensitive to predict unfavorable evolution and death 14,15 . The results of the present study did not demonstrate a correlation of lactate levels and organic dysfunction evaluated by the SOFA score.…”

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confidence: 99%

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Lactato como prognóstico de mortalidade e falência orgânica em pacientes com síndrome da resposta inflamatória sistêmica

Cicarelli¹,

Vieira²,

Benseñor³

2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:A síndrome da resposta inflamatória sistêmica (SRIS) é comum em pacientes em estado crítico no pós-operatório. O objetivo deste estudo foi investigar a correlação entre dosagem de lactato, disfunção de múltiplos órgãos e mortalidade em pacientes com diagnóstico de SRIS. MÉTODO: BACKGROUND AND OBJECTIVES:The systemic inflammatory response syndrome (SIRS) is common in the postoperative period of critically ill patients. The objective of this study was to investigate the correlation between lactate level, multiple organ dysfunction, and mortality in patients with SIRS. ). Multiple organ failure was evaluated by the SOFA (Sequential Organ Failure Assessment) score daily, for 7 days. After the 7-day follow-up period patients were followed for up to 28 days, until discharge from the hospital or death. METHODS: RESULTS:Thirteen patients were included in the LE Group after the diagnosis of SIRS and 11 patients in the LN Group. The relative risk (RR) of death in 7 days for the LE Group was 4.23 (CI 95% 2.25-7.95) times greater than in the LN Group in the first day of the study. The RR of death in 28 days was 1.7 times greater for the LE Group (CI 95% 0.84-3.46). The SOFA score was similar in both groups. CONCLUSIONS:Patients with elevated lactate in the first 24 hours after the diagnosis of SIRS did not have more organic dysfunction than patients with normal lactate levels, but they had an increased risk of death in 7 days.

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Lactato como prognóstico de mortalidade e falência orgânica em pacientes com síndrome da resposta inflamatória sistêmica

Cicarelli¹,

Vieira²,

Benseñor³

2007

Rev. Bras. Anestesiol.

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“…The functions of the lung parenchyma, measured by the p a O 2 , S a O 2 and p A-a O 2 parameters, did not change in both groups of animals monitored. Metabolic acidosis accompanies the development of SIRS and the analysis of blood gases and/or parameters of anaerobic metabolism, as confirmed by prior studies, may be suitable not only for the evaluation of the actual state of the patient but also for prognostic purposes (Smith et al, 2001;Marecaux et al, 1996). The increased anion gap values in the SS group at the end of the experiment correspond with the metabolic acidosis and the drop in the concentration of bicarbonates.…”

Section: Discussionmentioning

confidence: 59%

Model of septic shock induced by live E. coli (O18) in a laboratory rat

Dembovska¹,

Svoboda²,

Scheer³

et al. 2008

Vet. Med. - Czech

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ABSTRACT:This study was concerned with the development of induced septic shock in a laboratory rat using a series of measurements including body temperature, heart and respiratory rates, haematocrit value, red and white blood cell counts, differential leukocyte count, haemoglobin value, glycaemia, analysis of arterial blood gases, and serum levels of interleukin 6 (IL-6) during the first five hours. A total of 12 specific pathogen free (SPF) laboratory rats were used for the study. Septic shock was induced under general anaesthesia by introducing live E. coli (O18) into the jugular vein in the dose of 1 × 10 9 per 100 g of body weight (group SESH). Clinical measurements and blood collection from a. carotis were performed just prior to, and then 1.5 and 5 h after the administration of E. coli. The control group (C) contained 9 SPF laboratory rats which received physiological saline only, at the same volume into the jugular vein, and blood collection followed according to the same scheme as above described for group SESH. The results of the experiment showed that changes in clinical, haematological and biochemical parameters could be detected as early as 1.5 hours after induction. These changes correspond with the activation of an inflammatory reaction and the development of metabolic acidosis. They are accompanied by a considerable rise in IL-6 already 1.5 h after the application of live E. coli and after 5 h the levels exceeded 2 000 pg/ml in all experimental animals. Our results clearly document the importance of IL-6 for the early detection of developing septic shock and of some less specific but routinely determined parameters such as white blood cell count and base excess.

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“…23,24 Marecaux et al showed that, when correlated with other markers, lactate has a better prognostic value than the tumor necrosis factor and IL-6. 25 Smith et al concluded that lactate can be used for the prognosis of outcome in (adult) ICU patients. 22 Besides these studies with adults, observations in pediatric patients for the establishment of laboratory parameters as predictors of death have presented controversial results.…”

Section: Discussionmentioning

confidence: 99%

Lactato sérico como marcador prognóstico em crianças gravemente doentes

Koliski¹,

Cat²,

J³

et al. 2005

J. Pediatr. (Rio J.)

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Objective: To assess the use of lactate as a marker of tissue hypoperfusion and as a prognostic index in critically ill patients.Methods: Prospective, longitudinal, observational study of 75 patients admitted to the pediatric ICU of Hospital de Clínicas of Universidade Federal do Paraná, between November 1998 and May 1999. According to the lactate level on admission, patients were divided into group A (lactate > 18 mg/dl) and group B (lactate < 18 mg/dl). In terms of outcome, patients were classified into survivors and nonsurvivors. In group A, the clinical evaluation and the collection of arterial blood samples were performed on admission, at 6, 12, 24, 48 hours, and every 24 hours after that. In group B, they were carried out in the same way, but interrupted 48 hours after admission.Results: Groups A and B consisted of 50 and 25 patients, respectively. Group A presented more clinical signs of hypoperfusion (24/50). There was a statistically significant difference regarding the mean lactate levels on admission between those patients who died within 24 hours of admission (95 mg/dl) and those who died 24 hours after admission (28 mg/dl). The lactate level at 24 hours of admission revealed better sensitivity (55.6%) and specificity (97.2%) as a predictor of death.Conclusions: Most patients with lactate levels > 18 mg/dl showed clinical signs of hypoperfusion on admission. The normalization or reduction of lactate levels at and after 24 hours of admission was significantly related with higher chances of survival.J Pediatr (Rio J). 2005;81(4):287-92: Blood lactate, lactic acidosis, hyperlactatemia, prognostic index, PICU mortality.

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Blood lactate levels are better prognostic indicators than TNF and IL-6 levels in patients with septic shock

Abstract: These data indicate that the large variability in TNF alpha and IL-6 levels limit their prognostic significance in patients with septic shock. The predictive value of the trend in cytokine levels over time is not superior to that of trends in blood lactate levels.

Cited by 103 publications

References 37 publications

Lactato como prognóstico de mortalidade e falência orgânica em pacientes com síndrome da resposta inflamatória sistêmica

Lactato como prognóstico de mortalidade e falência orgânica em pacientes com síndrome da resposta inflamatória sistêmica

Model of septic shock induced by live E. coli (O18) in a laboratory rat

Lactato sérico como marcador prognóstico em crianças gravemente doentes

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