Serum Lactate as a Predictor of Mortality in Emergency Department Patients with Infection

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

“…As the cardiovascular system is designed to preserve arterial blood pressure to maintain cerebral and coronary perfusion during stress by reducing perfusion to peripheral tissues, the routine vital signs, central venous pressure and urinary output [89,90] may be relatively insensitive measures of early circulatory shock (also known as "cryptic shock" [90]), whereas serum lactate levels can serve as a marker of occult hypoperfusion [91,92]. Indeed, patients with cryptic hypoperfusion are often overlooked as candidates for aggressive interventions because they are hemodynamically stable [93], but they are associated with increased mortality [92,[94][95][96][97]. Thus, the main endpoint in sepsis treatment is to recognize the imbalance between oxygen delivery/demand measuring serum lactate in order to start resuscitation promptly [70,93] (the so called Early Goal directed therapy (EGDT)).…”

Fluid Volume, Lactate Values, and Mortality in Sepsis Patients with Intermediate Lactate Values

“…Prior studies have established lactate values as a prognostic marker for sepsis mortality, but have focused primarily on patients with the most severe sepsis (11,16,17,26,27). A handful of smaller studies evaluated patients with sepsis with intermediate lactate values and reported similar findings (15,16,18,(28)(29)(30).…”

“…Even those with normal blood pressure and "intermediate" lactate levels (>2.0 and ,4.0 mmol/L) have hospital mortality exceeding 10% (14)(15)(16)(17)(18), and, although their mortality rate is lower, their contribution to hospital deaths is on par with that of patients with the most severe sepsis, because they represent a larger fraction of all patients with sepsis (1,19). Despite this, there are limited data and no established guidelines for treating patients with sepsis with intermediate lactate values (10).…”

Evidence‐based sepsis therapy: A hospitalist perspective

“…36 They randomized 263 patients with septic shock (defined as hypotension Ͻ 90 mm Hg after a 20-30 mL/kg bolus, or lactate Ͼ 4 mmol/L, which is associated with at least a 3-fold increase in the mortality of emergency department patients with suspected infection 37 ) to either standard care or early goal-directed therapy (EGDT) for the initial 6 hours of hospital care. Patients with acute coronary ischemia, pulmonary edema, stroke, asthma, overdose, trauma, dysrhythmia, immunosuppression, uncontrolled cancer, or a need for urgent procedures were excluded.…”