Lactate clearance for death prediction in severe sepsis or septic shock patients during the first 24 hours in Intensive Care Unit: an observational study

Abstract

BackgroundThis study was design to investigate the prognostic value for death at day-28 of lactate course and lactate clearance during the first 24 hours in Intensive Care Unit (ICU), after initial resuscitation.MethodsProspective, observational study in one surgical ICU in a university hospital. Ninety-four patients hospitalized in the ICU for severe sepsis or septic shock were included. In this septic cohort, we measured blood lactate concentration at ICU admission (H0) and at H6, H12, and H24. Lactate clearance was calculated as followed: [(lactateinitial - lactatedelayed)/ lactateinitial] x 100%].ResultsThe mean time between severe sepsis diagnosis and H0 (ICU admission) was 8.0 ± 4.5 hours. Forty-two (45%) patients died at day 28. Lactate clearance was higher in survivors than in nonsurvivors patients for H0-H6 period (13 ± 38% and −13 ± 7% respectively, p = 0.021) and for the H0-H24 period (42 ± 33% and −17 ± 76% respectively, p < 0.001). The best predictor of death at day 28 was lactate clearance for the H0-H24 period (AUC = 0.791; 95% CI 0.6-0.85). Logistic regression found that H0-H24 lactate clearance was independently correlated to a survival status with a p = 0.047 [odds ratio = 0.35 (95% CI 0.01-0.76)].ConclusionsDuring the first 24 hr in the ICU, lactate clearance was the best parameter associated with 28-day mortality rate in septic patients. Protocol of lactate clearance-directed therapy should be considered in septic patients, even after the golden hours.

Extracellular histone H3 levels are inversely correlated with antithrombin levels and platelet counts and are associated with mortality in sepsis patients

“…In non-survivors of sepsis, we observed a consumption coagulopathy state, characterized by decreased antithrombin and prothrombin levels, decreased platelet counts, prolonged PT and CAT lag time, all pointing towards an up-regulation of haemostatic processes and consumption of coagulation proteins. We confirm that nonsurvivors present with significantly increased CAT lag times and lactate/LDH levels and that septic shock patients have decreased platelet counts, as well as decreased prothrombin and antithrombin levels [25][26][27][28][29][30][31]. Likewise our data support the view that different functional methods of coagulation assessment may result in different outcomes when tested for this particular type of patients (cf.…”

“…Other causes for increased lactate/LDH levels includes a decreased clearance of lactate by the liver [35,36]. Previous research [25,30,31] has shown that increased lactate levels or the failure to clear lactate or LDH within the first 24-48 hours after ICU admittance are strong predictors of mortality in sepsis patients, in agreement with the significantly increased lactate/LDH activity levels observed in non-survivors (P = 0.001), compared to survivors of sepsis in our study.…”

Lactate clearance and mortality in pediatric sepsis

“…Logistic regression analysis showed that lactate clearance was associated with mortality in sepsis patients (OR 0.35; 95%CI 0.01 to 0.76; P=0.047). 18 In our study, low lactate clearance was significantly associated with greater risk of mortality A previous study used lactate clearance as a benchmark of the success of early goal-directed therapy (eGDT) in patients with sepsis. In the study, lactate clearance was a good indicator for assessing the success of the first 6 hours of eGDT in septic patients.…”

Lactate clearance: its relationship with the success of non-operative management in patient with blunt abdominal trauma

“…For septic patients in the ICU, a lactate clearance-directed therapy in the first 6 hours appeared as efficient as ScvO2 measurement. 15 However no data are availabe for lactate-directed therapy for longer duration, nor on blunt abdominal trauma settings in the emergency room.…”