Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock

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Abstract

Purpose:

Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4 mmol/L, we compared mortality prediction between a subsequent lactate ≥4 mmol/L to a <10% and <20% decrease between initial and subsequent lactate values.

Materials and methods:

We performed a single-center retrospective study of patients presenting to the emergency department with an initial lactate ≥4 mmol/L and suspected infection. Patients were stratified by lactate reduction using 3 previously identified definitions (subsequent lactate ≥4 mmol/L, and <10% and <20% relative decrease in lactate) and compared using multivariable logistic regression. Sensitivity and specificity were compared using McNemar test.

Results:

A subsequent lactate ≥4 mmol/L and a lactate reduction <20% were associated with increased in-hospital mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.24-8.16; P = .02 and OR, 3.11; 95% CI, 1.39-6.96; P = .006, respectively), whereas a lactate reduction <10% was not (OR, 1.13; 95% CI, 0.94-1.34; P = .11). A subsequent lactate ≥4 mmol/L and a lactate reduction <20% were more sensitive than a lactate reduction <10% (72% vs 41%, P = .002 and 62% vs 41%, P = .008, respectively) but less specific (57% vs 76%, P < .001 and 67% vs 76%, P = .002, respectively).

Conclusions:

A subsequent lactate ≥4 mmol/L and lactate reduction <20% were associated with increased in-hospital mortality, whereas a lactate reduction <10% was not. Sensitivity and specificity are different between these parameters.

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