The Effect of Lactate and Lactate Clearance on Mortality in Sepsis Patients Admitted to the Emergency Department (original) (raw)
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Tüberküloz ve toraks, 2015
Risk factors for multiorgan failure and mortality in severe sepsis patients who need intensive care unit follow-up Introduction: Multiorgan failure (MOF) is a primary cause of morbidity and mortality in sepsis patients in intensive care units (ICU). Finding risk factors and solving preventable problems of MOF in patients who have sepsis can be a favourable step for decreasing mortality. We aimed to examine multiorgan failure and mortality related risk factors in intensive care unit patients who have sepsis. Materials and Methods: A retrospective data collection and prognostic cohort study was performed. Between January 2009-March 2010, patients accepted to the 22-bed pulmonary intensive care unit with the diagnosis of sepsis were enrolled. Patients' demographic data, ICU severity scores, application of mechanical ventilation, causative agent of sepsis, number of ICU days and presence of mortality were recorded. Logistic regression analysis was carried out for risk factors. Results: 347 patients with sepsis were involved in the study. 43 of the patients (12.4%) developed MOF and overall mortality rate was 14.9% (n= 52). Presence of resistant pathogen, presence of shock, application of TPN and high APACHE II score were found to be risk factors for MOF [p= 0.015 Odds ratio (OR) 3.47
Istanbul Medical Journal, 2019
Amaç: Sepsis hastanede yatan hastalarda en önemli ölüm nedenlerinden biri olsa da mortalite ve morbiditeyi öngörmeye yönelik erken prediktif faktörlerle ilgili bilgiler sınırlıdır. Bu çalışmada acil servise başvuran ve sepsis ön tanılı 65 yaş ve üzeri erişkin hastalarda tanımlanmış arteriyel kan gazı parametreleriyle 30 günlük mortalite arasındaki ilişkinin belirlenmesi amaçlandı. Yöntemler: Mart-Ağustos 2017 tarihleri arasındaki 5 aylık süreçte acil serviste sepsis ön tanısı konulmuş 65 yaş üzeri hastaların arteriyel kan gazı parametreleri retrospektif olarak incelendi. Kan gazı parametrelerinden pH, laktat, anyon açığı, bikarbonat ve baz açığı ile 30 günlük mortalite arasındaki ilişki analiz edildi. Bulgular: Sepsis tanılı 103 yaşlı hasta çalışmaya dahil edildi. Hastaların 58'i (%56,3) kadındı ve yaş ortalaması 77,74±8,45 yıl (aralık: 65-99) olarak saptandı. Hastaların 22 (%21,4) tanesi 30 gün içerisinde öldü. Başvuru "Hızlı Sepsisle İlgili Organ Yetmezliği Değerlendirmesi" değerleri 32 (%31,1) hastada 2 veya daha üzeri olarak saptandı. Parametrelerden bikarbonat (p=0,001), laktat (p<0,001), anyon açığı (p=0,007) ve baz açığı (p=0,001) değerlerinin 30 günlük mortalite ile anlamlı olarak ilişkili olduğu bulundu. Sonuç: Çalışmamızda 65 yaş ve üzeri sepsis ön tanılı hastalarda arteriyel kan gazında saptanan laktat, bikarbonat, anyon açığı ve baz fazlalığı düzeylerinin 30 günlük mortalite ile ilişkili olduğunu saptadık. Septik hastalarda bu parametreler yakından izlenmelidir. Bu parametrelerin izlenmesi, sepsis ön tanılı acil servis hastalarında erken klinik karar almaya yardımcı olabilir ve sepsis sonucunu etkileyebilir.
Emergency Medicine Journal, 2012
Background The tendency of sepsis to progress rapidly and the benefit of an early start of treatment emphasise the importance of fast risk stratification in the emergency department (ED). The aim of the present work was to validate the Mortality in Emergency Department Sepsis (MEDS) score as a predictor of 28-day mortality in ED patients with sepsis in The Netherlands, and to compare its performance to C reactive protein (CRP) and lactate. Methods This was a historical cohort study in a secondary and tertiary care university hospital. Patients were included if they were seen by an internist in the ED, fulfilled the clinical criteria for sepsis and were admitted to the hospital. Primary outcome was all-cause in-hospital mortality within 28 days. Results In the 6-month study period, 331 patients were included, of whom 38 (11.5%) died. Mortality varied significantly per MEDS category: #4 points (very low risk: 3.1%), 5e7 points (low risk: 5.3%), 8e12 points (moderate risk 17.3%), 13e15 points (high risk: 40.0%), >15 points (very high risk: 77.8%). Receiver operating characteristic (ROC) analysis showed that the MEDS score predicted 28-day mortality better than CRP (area under the curve (AUC) values of 0.81 (95% CI 0.73 to 0.88) and 0.68 (95% CI 0.58 to 0.78), respectively). Lactate was not measured in enough patients (47) for a valid evaluation, but seemed to predict mortality at least fairly (AUC 0.75, 95% CI 0.60 to 0.90). Conclusions The MEDS score is an adequate tool for predicting mortality in patients with sepsis in a Dutch internistic ED population. CRP is less useful in this context. Lactate appears to be at least a fair predictor of mortality, but needs to be investigated more systematically in a larger population.
A study on serum lactate levels as a prognostic marker of sepsis
2021
Background: Sepsis and septic shock are a leading cause of mortality worldwide. An elevated serum lactate level is an early maker of sepsis induced hypoperfusion. This study evaluates the clinical utility of lactate clearance and serum lactate levels in sepsis as a prognostic marker in these patients. Materials and Methods: An observational study was conducted over a period of 1 year and 109 ICU patients diagnosed with sepsis or septic shock were included. Mortality analysis was done using Chisquare test and unpaired t test. ‘p’ value < 0.05 was considered as statistically significant. Correlation coefficients were calculated for comparison of blood lactate levels with mean arterial pressure, serum creatinine and heart rate. The area under the receiver operating characteristic curve (AUROC) analysis was carried out for lactate levels at various time intervals, lactate/albumin ratio and lactate clearance to predict in house mortality; with AUROC closer to 1.0 being significant. Re...
Introduction: De nombreuses études ont démontré que l’état de sepsis augmente le taux de mortalité qui varie de 20 à 49% dans le monde. Au Moyen-Orient, notamment au Liban, les données sur l’émergence de sepsis, ses complications et son impact sur la mortalité, sont rares et peu documentées Objectifs: Evaluer l'état de sepsis et ses critères de sévérité, ainsi que son impact sur la mortalité en service de soins intensifs. Méthodologie: Il s'agit d'une étude descriptive conduite rétrospectivement dans les unités de soins intensifs de deux hôpitaux libanais, incluant les patients hospitalisés, entre Février et juin 2012 ayant été traités par des antibiotiques et/ou développant un état de sepsis. Des fiches de recueil des données ont été remplies à partir des dossiers des patients. Des analyses binaires et logistiques ont été réalisées utilisant le SPSS version 20. Résultats: Au total, 248 patients ont été inclus dans cette étude dont 37.5% avaient un âge ≥ à 75 ans, 46.4% ...
Bali Medical Journal, 2018
Background: Sepsis is a life-threatening organ dysfunction, caused by the dysregulation of the body's response to infection. Sepsis remains one of the major causes of hospitalization and mortality in hospitals with large medical expenses. Sequential (sepsis-related) organ failure assessment/SOFA is a score that describes the presence of organ dysfunctions. Lactate is a metabolite formed anaerobic respiration due to hypoperfusion. This study was conducted to determine the role of SOFA score as a predictor of sepsis mortality and its association with capillary lactate levels. Method: This was an observational study with a cohort design. A sample of 68 subjects with sepsis was taken using consecutive sampling. Calculation of the SOFA score was performed at the beginning of sepsis diagnosis whilst capillary lactate examination was performed in the first 3 hours after diagnosis. Result: The most frequent cases of organ dysfunction based on SOFA score was respiration system (83.8%), kidney (58.8%), central nervous system (55.9%), cardiovascular (41.2%), coagulation (36.8%), hepatobiliary (23.5%). The mean score of SOFA and the initial capillary lactate level of the living group compared with the deceased group was 4.89±2.06 vs. 7.64±2.67 (p <0.05); 3.28±1.39 vs 3.60±1.43 (p 0.116). The best cutoff values of the SOFA score for mortality were ≥ 5.5 (area under curve/AUC 0.788, sensitivity 74.2% and specificity 62.2%, positive predictive value/ PPV 62.2%, and negative predictive value/NPV 74.2%). The logrank test of the Kaplan-Meier curve was statistically significant (p <0.05). Multivariate Cox regression analysis showed that the SOFA score with cutoff ≥5.5 could be used as a predictor of mortality in sepsis patients with a hazard ratio of 2.475 (p <0.05). Spearman correlation test between SOFA score with initial capillary lactate level was statistically significant (p <0.05) with correlation coefficient 0.319 (weak correlation) Conclusion: The SOFA score with cutoff ≥5.5 can be used as a predictor of mortality in sepsis. The SOFA score correlated weakly with capillary lactate levels.
Cureus
Background and objective Sepsis is a major health burden that leads to significant morbidity and mortality. Early diagnosis and severity prediction using various scoring systems can reduce the mortality rate, particularly in developing nations. There are two aims of this study. One is to evaluate the prognostic accuracy of the Sequential Organ Failure Assessment (SOFA) score and serum lactate levels in patients with sepsis to predict mortality. The other aim is to evaluate the relationship between the SOFA score and lactate so that we may be able to use lactate as a surrogate predictor of organ dysfunction and mortality in sepsis. Methods An observational prognostic accuracy study was conducted in the
The objective of this study was to identify the initial value of blood lactate that best correlates with 28-day mortality in resuscitated septic shock patients. This was a retrospective cohort study including 443 patients admitted to an intensive care unit (ICU) with severe sepsis or septic shock from the emergency department. A receiver-operating characteristic (ROC) curve was drawn to obtain the best cutoff value for initial blood lactate associated with 28-day mortality. Patients were then dichotomized according to the chosen lactate cutoff, and sensitivity, specificity, and positive and negative predictive values were calculated. Baseline blood lactate level more than 2.5 mmol/L showed the largest area under the ROC curve to predict 28-day mortality (ROC area, 0.70; 95% confidence interval [CI], 0.62-0.79), with sensitivity, specificity, and negative predictive value of 67.4%, 61.7%, and 94.2%, respectively. Mortality at 28 days was 16.9% (31/183) in patients with initial lactate more than 2.5 mmol/L and 5.8% (15/260) in patients with initial lactate at most 2.5 mmol/L (relative risk, 2.93; 95% CI, 1.63-5.28; P < 0.001). Initial blood lactate levels more than 2.5 mmol/L (hazard ratio [HR], 2.86; 95% CI, 1.53-5.33; P ¼ 0.001) and Sepsis-related Organ Failure Assessment score at ICU admission (HR, 1.18; 95% CI, 1.09-1.27; P < 0.001) were associated with increased 28-day mortality in the adjusted Cox regression. In this retrospective cohort study, a lactate level more than 2.5 mmol/L was the best threshold to predict 28-day mortality among severe sepsis and septic shock patients. Further prospective studies should address the impact on morbidity and mortality of this threshold as a trigger to resuscitation in this population of critically ill patients.
Implication of a Sepsis Protocol in a Respiratory Intensive Care Unit: A 12 Month Experience
Dahili ve Cerrahi Bilimler Yoğun Bakım Dergisi/ Turkish Journal of Medical and Surgical Intensive Care, 2010
Giriş: Kritik hastalıklarda protokole dayalı tedavi yaklaşımında hasta prognozlarının daha iyi olduğu gösterilmiştir. Çalışmamızda göğüs hastalıkları yoğun bakım ünitemizde (YBÜ) bir yıllık dönemde sepsis protokolü uygulaması sonuçları ve protokol uygulanan hastalarda mortalite için risk faktörlerini araştırmayı hedefl edik. Gereç ve Yöntemler: Tanımlayıcı klinik çalışma olarak planlandı. 2006 yılında solunumsal YBÜ'ye kabul edilen ve 24 saatten fazla kalan erişkin ciddi sepsis ve septik şoktaki hastalar çalışmaya alındı. Hastaların özellikleri, tedavileri ve prognozları değerlendirildi. Sepsis protokolü olarak ortalama arteryel kan basıncı >65 mmHg olacak şekilde erken hedefe yönelik tedavi, ortalama 6 ml/kg olacak şekilde düşük tidal volüm, kan şekeri 80-140 mg/dl olacak şekilde glisemik kontrol ve tedaviye dirençli şokta günde 3 kez 20 mg metilprednizolon uygulandı. Protokol ugulanan ciddi sepsis hastalarında mortalite için risk faktörleri lojistik regresyon analizi ile değerlendirildi. Bulgular: Çalışma dönemindeki 176 hastanın 119 (67.6%)'unda ciddi sepsis kriterleri bulundu ve çalışmaya dahil edildi. Ciddi sepsis hastalarının YBÜ'ye kabuldeki APACHE II değeri ortalama 20.5±6.8 idi. Yaşayan ve ölen ciddi sepsisli hastalar karşılaştırıldığında yüksek APACHE II değeri; invaziv mekanik ventilasyon, vazopressör, insulin, albumin, total parenteral beslenme (TPB) uygulamaları; çoklu organ yetmezliği (ÇOY) varlığı ölenlerde anlamlı olarak fazla bulundu. Lojistik resresyon analizinde ÇOY varlığı, TPB uygulaması ve yüksek APACHE II değeri mortalite için risk faktörleri olarak bulundu (sırasıyla OR 23.8 (7.17-78.85), p=0.0001; OR 4.5 (1.26-16.9), p=0.020; OR 1.1 (1.006-1.19), p=0.036). APACHE II skoruna göre beklenen mortalite %35.5 iken, gözlenen mortalite %24.4 (n=29) idi. Sonuç: Sepsis protokolü uygulanan hastalarımızda APACHE II ye göre beklenenden düşük mortalite gözlendi. Mortalite için ÇOY, TPB ve yüksek APACHE II değeri risk faktörü olarak bulundu.
Study of Significance of Serum Lactate Kinetics in Sepsis as Mortality Predictor
Indian Journal of Critical Care Medicine
Introduction: Sepsis is one of the leading causes of death worldwide. Serum lactate is being used in sepsis for diagnostic and prognostic purposes for years now. In this study, we shed light over a novel use of lactate in form of various clearance parameters to determine mortality in septic patients at the 28th day. Materials and method: In our study, 200 patients with sepsis were included using quick sequential organ failure assessment (qSOFA) score and their lactate levels were measured at the time of admission (0 hour) and 24 hours after admission. Lactate clearance parameters (absolute and relative lactate clearance, lactate clearance rate) were calculated. All patients were followed up for a period of 28 days to determine the outcome, and data analysis was done accordingly. Results and conclusion: Our study showed that higher SOFA score, qSOFA score, and serum lactate levels were associated with increased 28th-day mortality. Low absolute, relative lactate clearance and lactate clearance rate were also associated with poor outcomes. The best cutoffs to predict poor outcomes were serum lactate level at 24 hours ≥4 mmol/L and relative lactate clearance ≤40.3% with good sensitivity and specificity.