BACKGROUND
As per the latest Surviving Sepsis Campaign guidelines, fluid resuscitation should be guided by repeated measurements of blood lactate levels until normalization. Nevertheless, raised lactate levels should be interpreted in the clinical context, as there may be other causes of elevated lactate levels. Thus, it may not be the best tool for real-time assessment of the effect of hemodynamic resuscitation, and exploring alternative resuscitation targets should be an essential research priority in sepsis.
AIM
To compare the 28-d mortality in two clinical patterns of septic shock: hyperlactatemic patients with hypoperfusion context and hyperlactatemic patients without hypoperfusion context.
METHODS
This prospective comparative observational study carried out on 135 adult patients with septic shock that met Sepsis-3 definitions compared patients with hyperlactatemia in a hypoperfusion context (Group 1,
n
= 95) and patients with hyperlactatemia in a non-hypoperfusion context (Group 2,
n
= 40). Hypoperfusion context was defined by a central venous saturation less than 70%, central venous-arterial PCO
2
gradient [P(cv-a)CO
2
] ≥ 6 mmHg, and capillary refilling time (CRT) ≥ 4 s. The patients were observed for various macro and micro hemodynamic parameters at regular intervals of 0 h, 3 h, and 6 h. All-cause 28-d mortality and all other secondary objective parameters were observed at specified intervals. Nominal categorical data were compared using the
χ
2
or Fisher’s exact test. Non-normally distributed continuous variables were compared using the Mann-Whitney
U
test. Receiver operating characteristic curve analysis with the Youden index determined the cutoff values of lactate, CRT, and metabolic perfusion parameters to predict the 28-d all-cause mortality. A
P
value of < 0.05 was considered significant.
RESULTS
Patient demographics, comorbidities, baseline laboratory, vital parameters, source of infection, baseline lactate levels, and lactate clearance at 3 h and 6 h, Sequential Organ Failure scores, need for invasive mechanical ventilation, days on mechanical ventilation, and renal replacement therapy-free days within 28 d, duration of intensive care unit stay, and hospital stay were comparable between the two groups. The stratification of patients into hypoperfusion and non-hypoperfusion context did not result in a significantly different 28-d mortality (24%
vs
15%, respectively;
P
= 0.234). However, the patients within the hypoperfusion context with high P(cv-a)CO
2
and CRT (
P
= 0.022) at baseline had significantly higher mortality than Group 2. The norepinephrine dose was higher in Group 1 but did ...
