Utility of the Early Lactate Area Score as a Prognostic Marker for Septic Shock Patients in the Emergency Department

Abstract

Background The current Surviving Sepsis Campaign guidelines recommend the remeasurement of lactate levels if the initial lactate level is elevated; however, the prognostic value of lactate kinetics is limited and inconsistent. We attempted to determine the efficacy of the lactate area score (calculated from repeated lactate measurements during initial resuscitation) as a prognostic marker of septic shock in the emergency department (ED).Methods We performed a retrospective study of adult patients with septic shock in the ED of a single tertiary medical center. Serial lactate levels were measured five times within 12 hours. We also compared the initial lactate level, maximum lactate level, and lactate area score. The lactate area score was defined as the sum of the area under the curve measured at 2, 4, 6, and 12 hours following the initial measurement.Results A total of 362 patients were enrolled in this study, and the overall 28-day mortality was 31.8%. The lactate area score of serial lactate levels as well as the initial (median [interquartile range], 4.9 [3.4 to 10.5]; P=0.003) and maximum (7.3 [4.2 to 13.2]; P<0.001) lactate levels were significantly higher in the non-survivor group. However, in multivariate analysis, only the lactate area score (odds ratio, 1.013; 95% confidence interval, 1.007 to 1.019) was significantly associated with 28-day mortality.Conclusions The early lactate area score may be a possible prognostic marker for predicting the 28-day mortality of adult septic shock patients. Further prospective interventional studies should be conducted to validate our results.

Association between normalized lactate load and mortality in patients with septic shock: an analysis of the MIMIC-III database

“…Our data suggest that normalized lactate load may be an independent risk factor of mortality in septic shock patients. Although similar findings have been found in a few previous studies [ 13 – 16 ], it has not been investigated in a large cohort of adult septic shock patients like our study population. Nichol et al found that time-weighted average lactate, which was defined as “summing the mean value between consecutive time points multiplied by the period of time between consecutive time points and then dividing by the total time”, was independently predictive of hospital mortality in a heterogeneous cohort of critically ill patients, with an OR of 1.37 (95% CI: 1.29 to 1.45) [ 13 ].…”

“…Such indices have been shown to be associated with worse outcomes in pediatric septic shock patients [ 14 ], post-cardiosurgical patients [ 17 ] and heterogeneous cohorts of critically ill patients [ 13 ]. In addition, adult septic shock patients were also investigated in two studies [ 15 , 16 ]. However, these variables have not been validated in a large cohort of adult septic shock patients.…”

“…A new approach to examine the dynamic lactate changes has been proposed in the 2010s, which incorporates both the magnitude of change and the time interval of such change [13][14][15][16]. The dynamic change of lactate over time is plotted, and the area under the curve (AUC) represents the overall lactate burden, termed "lactate area" [14], "lactate area score" [15,16] or "lactate load" [17]. With the AUC divided by the time interval, the result represents the averaged lactate load in this period, termed "time-weighted average lactate" [13] or "normalized lactate load" [17].…”

A Graphene-Based Enzymatic Biosensor Using a Common-Gate Field-Effect Transistor for L-Lactic Acid Detection in Blood Plasma Samples

“…It also can be related to higher energy demand and it is a common target for monitoring of physical exercise routine [ 5 ]. However, the elevated concentration of lactate is also related to tissue hypoxia and accelerated aerobic metabolism, being a prognosis marker for different disorders, e.g., septic shock and left ventricular failure [ 5 , 6 , 7 ]. It is essential to detect the lactic acidosis level in the patient to accelerate the treatment outcome and decrease the mortality rate caused by sepsis [ 5 ].…”

Recent lactate findings: is repeated serum lactate testing necessary in septic shock patients?

“…The authors found that serial lactate measurements with five times within 12 hours and lactate area score were independently associated with 28-day mortality. Unfortunately, the lactate area score showed a lower odds ratio than had been reported in previous studies or that of the SOFA score for predicting mortality [19].…”