Lactate Level Versus Lactate Clearance for Predicting Mortality in Patients With Septic Shock Defined by Sepsis-3

Ryoo, Seung Mok; Lee, Jung Bok; Lee, Yoon‐Seon; Lee, Jae Ho; Lim, Kyoung Soo; Huh, Jin Won; Hong, Sang‐Bum; Lim, Chae‐Man; Koh, Younsuck; Kim, Won Young

doi:10.1097/ccm.0000000000003030

Cited by 186 publications

(169 citation statements)

References 23 publications

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“…Nguyen et al [7] showed that a lower ΔLac 0-6h, obtained at 0h and 6h after admission to ED, was significantly associated with in-hospital mortality in 111 adult patients with severe sepsis or septic shock. Similarly, Ryoo et al [8] reported that median 6h repeated lactate concentrations and ΔLac 0-6h were significantly associated with 28-day mortality in 1,060 adult patients with septic shock. In contrast, the raw data for ΔLac varied considerably, resulting in a lower diagnostic ability [7,8].…”

Section: Dynamic Lactate Indexmentioning

confidence: 87%

“…Similarly, Ryoo et al [8] reported that median 6h repeated lactate concentrations and ΔLac 0-6h were significantly associated with 28-day mortality in 1,060 adult patients with septic shock. In contrast, the raw data for ΔLac varied considerably, resulting in a lower diagnostic ability [7,8]. However, in the systematic review and meta-analysis for ΔLac, Zang and Xui [11] concluded that the diagnostic performance of ΔLac remained at a moderate accuracy level in the heterogenous ICU population.…”

Section: Dynamic Lactate Indexmentioning

confidence: 87%

“…Several dynamic lactate indices have been shown as effective predictors of outcome in ICU patients. ΔLac, also called lactate clearance in some articles, has been extensively studied [7][8][9][10][11]. However, use of the term "clearance" has been criticized because of its general meaning of elimination and the need for intravenous injection of radiolabeled lactate to directly measure clearance [2,12].…”

Section: Dynamic Lactate Indexmentioning

confidence: 99%

“…Dynamic indices based on serial lactate changes may be more informative than static ones. In particular, changes in lactate concentrations (Δ Lac) have been extensively studied [7][8][9][10][11]. However, adequate time intervals or optimal cut-off values for Δ Lac have varied considerably among studies [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Lactate indices as predictors of in-hospital mortality or 90-day survival after admission to an intensive care unit in unselected critically ill patients

et al. 2020

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BackgroundWe performed an exclusive study to investigate the associations between a total of 23 lactate-related indices during the first 24h in an intensive care unit (ICU) and in-hospital mortality. MethodsNine static and 14 dynamic lactate indices, including changes in lactate concentrations (Δ Lac) and slope (linear regression coefficient), were calculated from individual critically ill patient data extracted from the Multiparameter Intelligent Monitoring for Intensive Care (MIMIC) III database. ResultsData from a total of 781 ICU patients were extracted, consisted of 523 survivors and 258 non-survivors. The in-hospital mortality rate for this cohort was 33.0%. A multivariate logistic regression model identified maximal lactate concentration at 24h after ICU admission (max lactate at T24) as a significant predictor of in-hospital mortality (odds ratio = 1.431, 95% confidence interval [CI] = 1.278-1.604, p<0.001) after adjusting for predefined confounders (age, gender, sepsis, Elixhauser comorbidity score, mechanical ventilation, renal replacement therapy, vasopressors, ICU severity scores). Area under curve (AUC) for max lactate at T24 was larger (AUC = 0.776, 95% CI = 0.740-0.812) than other indices (p<0.001), comparable to an APACHE III score of 0.771. When combining max lactate at T24 with APACHE III, the AUC was increased to 0.815 (95% CI:0.783-0.847). The sensitivity, specificity, and positive and negative predictive values for the cut-off value of 3.05 mmol/L were 64.3%, 77.4%, 58.5%, and 81.5%, respectively.Kaplan-Myer survival curves of the max lactate at T24 for 90-day survival after admission to ICU demonstrated a significant difference according to the cut-off value (p<0.001). ConclusionsThese data indicate that the maximal arterial lactate concentration at T24 is a robust predictor of in-hospital mortality as well as 90-day survival in unselected ICU patients with predictive ability as comparable with APACHE III score.

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Section: Dynamic Lactate Indexmentioning

confidence: 87%

Section: Dynamic Lactate Indexmentioning

confidence: 87%

Section: Dynamic Lactate Indexmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lactate indices as predictors of in-hospital mortality or 90-day survival after admission to an intensive care unit in unselected critically ill patients

et al. 2020

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“…In brief, aggressive uids infusion and vasopressors were applied with blood pressure monitoring. Lactate levels were checked via venous or arterial blood gas analysis, and a central venous catheter was placed routinely for administering high dose vasopressors and repetitive sampling [10,11].…”

Section: Data Collection and De Nition Of Variablesmentioning

confidence: 99%

Culture-negative and culture-positive septic shock: characteristics and clinical outcomes

Kim

2020

Preprint

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Background We evaluated the characteristics and outcomes of culture-negative septic shock versus culture-positive septic shock.Methods We performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality.Results Of 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 hours (aerobic 10.2 hours and anaerobic 9.0 hours). The most common site of infection among the culture-positive was the hepatobiliary tract (39.5%), while for the culture-negative was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p = 0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality.Conclusion Patients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with degree of organ dysfunction, it was not an independent predictor of death.

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New potential for an old kid on the block: Impact of premorbid metformin use on lactate kinetics, kidney injury and mortality in sepsis and septic shock, an observational study

Moorter

Tackaert

Decker

et al. 2022

Endocrino Diabet & Metabol

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Lactate Level Versus Lactate Clearance for Predicting Mortality in Patients With Septic Shock Defined by Sepsis-3

Cited by 186 publications

References 23 publications

Lactate indices as predictors of in-hospital mortality or 90-day survival after admission to an intensive care unit in unselected critically ill patients

Lactate indices as predictors of in-hospital mortality or 90-day survival after admission to an intensive care unit in unselected critically ill patients

Culture-negative and culture-positive septic shock: characteristics and clinical outcomes

New potential for an old kid on the block: Impact of premorbid metformin use on lactate kinetics, kidney injury and mortality in sepsis and septic shock, an observational study

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