Risk Factors for Mortality in Sepsis Patients without Lactate Levels Increasing Early

He, Miao; Huang, Jialin; Li, Xingxing; Liang, Shunda; Wang, Qing; Zhang, Hong

doi:10.1155/2023/6620157

Cited by 4 publications

(3 citation statements)

References 42 publications

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“…Lactate is an important marker of sepsis, and a delayed increase in lactate levels was reported to be independently associated with in-hospital mortality rate [ 31 ]. However, the lactate levels in the participants of the present study were unknown.…”

Section: Discussionmentioning

confidence: 99%

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

Nishino,

Kubota,

Kashiwagi

et al. 2024

Renal Failure

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Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), secondary to cardiovascular disease and sepsis, is associated with high in-hospital mortality. Although studies have examined cardiovascular disease and sepsis in AKI, the association between AKI and hepatic functional impairment remains unclear. We hypothesized that hepatic function markers would predict mortality in patients undergoing CRRT. We included 1,899 CRRT patients from a multi-centre database. In Phase 1, participants were classified according to the total bilirubin (T-Bil) levels on the day of, and 3 days after, CRRT initiation: T-Bil < 1.2, 1.2 ≤ T-Bil < 2, and T-Bil ≥ 2 mg/dL. In Phase 2, propensity score matching (PSM) was performed to examine the effect of a T-Bil cutoff of 1.2 mg/dL (supported by the Sequential Organ Failure Assessment score); creating two groups based on a T-Bil cutoff of 1.2 mg/dL 3 days after CRRT initiation. The primary endpoint was total mortality 90 days after CRRT initiation, which was 34.7% ( n = 571). In Phase 1, the T-Bil, aspartate transaminase (AST), alanine transaminase (ALT), and AST/ALT (De Ritis ratio) levels at CRRT initiation were not associated with the prognosis, while T-Bil, AST, and the De Ritis ratio 3 days after CRRT initiation were independent factors. In Phase 2, T-Bil ≥1.2 mg/dL on day 3 was a significant independent prognostic factor, even after PSM [hazard ratio: 2.41 (95% CI; 1.84-3.17), p < 0.001]. T-Bil ≥1.2 mg/dL 3 days after CRRT initiation predicted 90-day mortality. Changes in hepatic function markers in acute renal failure may enable stratification of high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

Nishino,

Kubota,

Kashiwagi

et al. 2024

Renal Failure

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show abstract

“…39 Indicators related to organ dysfunction, such as acute physiology and chronic health assessment II (APACHE II) score, APTT, total bilirubin, creatinine, hypotension, chronic kidney disease, and the need for continuous renal replacement therapy (CRRT), are associated with microcirculatory impairment and increased sepsis mortality. 40 Overall, reduced HCT and prolonged APTT are important indicators for predicting the prognosis of sepsis. It is worth noting that inflammation and coagulation often interact in the pathophysiological process of sepsis.…”

Section: Discussionmentioning

confidence: 99%

LASSO-Based Identification of Risk Factors and Development of a Prediction Model for Sepsis Patients

Hong,

Xiong,

Xia

et al. 2024

TCRM

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Objective The objective of this study was to utilize LASSO regression (Least Absolute Shrinkage and Selection Operator Regression) to identify key variables in septic patients and develop a predictive model for intensive care unit (ICU) mortality. Methods We conducted a cohort consisting of septic patients admitted to the ICU between December 2016 and July 2019. The disease severity and laboratory index were analyzed using LASSO regression. The selected variables were then used to develop a model for predicting ICU mortality. AUCs of ROCs were applied to assess the prediction model, and the accuracy, sensitivity and specificity were calculated. Calibration were also used to assess the actual and predicted values of the predictive model. Results A total of 1733 septic patients were included, among of whom 382 (22%) died during ICU stay. Ten variables, namely mechanical ventilation (MV) requirement, hemofiltration (HF) requirement, norepinephrine (NE) requirement, septicemia, multiple drug-resistance infection (MDR), thrombocytopenia, hematocrit, red-cell deviation width coefficient of variation (RDW-CV), C-reactive protein (CRP), and antithrombin (AT) III, showed the strongest association with sepsis-related mortality according to LASSO regression. When these variables were combined into a predictive model, the area under the curve (AUC) was found to be 0.801. The AUC of the validation group was 0.791. The specificity of the model was as high as 0.953. Within the probability range of 0.25 to 0.90, the predictive performance of the model surpassed that of individual predictors within the cohort. Conclusion Our findings suggest that a predictive model incorporating the variables of MV requirement, HF requirement, NE requirement, septicemia, MDR, thrombocytopenia, HCT, RDW-CV, CRP, and AT III exhibiting an 80% likelihood of predicting ICU mortality in sepsis and demonstrates high accuracy.

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“…Studies have suggested that lactate clearance serves as a marker for ongoing tissue hypoxia and can predict mortality in patients with severe sepsis [ 13 , 14 ]. Additionally, improving lactate clearance has been associated with better outcomes in patients with sepsis and AKI [ 15 , 16 ]. In the setting of cardiac surgery and extracorporeal life support (ECLS), elevated lactate levels and impaired lactate clearance have been linked to poor outcomes, emphasizing the importance of monitoring lactate dynamics [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Lactate Profile Assessment—A Good Predictor of Prognosis in Patients with COVID-19 and Septic Shock Requiring Continuous Renal Therapy

Trebuian,

Marza,

Chioibaş

et al. 2024

Clinics and Practice

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Introduction: Lactate is a useful prognostic marker, as its level increases in hypoxic tissue and/or during accelerated aerobic glycolysis due to excessive beta-adrenergic stimulation and decreased lactate clearance. The Surviving Sepsis Campaign Bundle 2018 Update suggests premeasurement of lactate within 2–4 h so that physicians perform, assist, administer, and introduce lactate-guided resuscitation to reduce mortality due to sepsis. Methods: A total of 108 patients with septic shock who underwent continuous renal replacement therapy (CRRT) for acute kidney injury were enrolled in this observational study. Demographic, clinical, and laboratory data were collected, and patients were divided into two groups: survivors and non-survivors. Results: Multivariate analysis demonstrated that lactate levels at 24 h after initiation of CRRT treatment, but not lactate levels at intensive care unit (ICU) admission, were associated with mortality. Lactate clearance was associated with lower mortality among the survivors (OR = 0.140) at 6 h after ICU admission and late mortality (OR = 0.260) after 24 h. The area under the ROC curves for mortality was 0.682 for initial lactate; 0.797 for lactate at 24 h; and 0.816 for lactate clearance at 24 h. Conclusions: Our result reinforces that the determination of lactate dynamics represents a good predictor for mortality, and serial lactate measurements may be more useful prognostic markers than initial lactate in patients with septic shock.

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Risk Factors for Mortality in Sepsis Patients without Lactate Levels Increasing Early

Cited by 4 publications

References 42 publications

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

LASSO-Based Identification of Risk Factors and Development of a Prediction Model for Sepsis Patients

Lactate Profile Assessment—A Good Predictor of Prognosis in Patients with COVID-19 and Septic Shock Requiring Continuous Renal Therapy

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