Outcomes of severe sepsis and septic shock patients after stratification by initial lactate value.

Autor: Chambers KA; Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA., Park AY; McGovern Medical School at UTHealth, Houston, TX, USA., Banuelos RC; McGovern Medical School at UTHealth, Houston, TX, USA., Darger BF; Department of Emergency Medicine, University of California, San Francisco, CA, USA., Akkanti BH; Division of Critical Care, Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA., Macaluso A; Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA., Thangam M; Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA., Doshi PB; Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA.; McGovern Medical School at UTHealth, Houston, TX, USA.; Division of Critical Care, Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA.
Jazyk: angličtina
Zdroj: World journal of emergency medicine [World J Emerg Med] 2018; Vol. 9 (2), pp. 113-117.
DOI: 10.5847/wjem.j.1920-8642.2018.02.005
Abstrakt: Background: In the setting of severe sepsis and septic shock, mortality increases when lactate levels are ≥ 4 mmol/L. However, the consequences of lower lactate levels in this population are not well understood. The study aimed to determine the in-hospital mortality associated with severe sepsis and septic shock when initial lactate levels are < 4 mmol/L.
Methods: This is a retrospective cohort study of septic patients admitted over a 40-month period. Totally 338 patients were divided into three groups based on initial lactate values. Group 1 had lactate levels < 2 mmol/L; group 2: 2-4 mmol/L; and group 3: ≥ 4 mmol/L. The primary outcome was in-hospital mortality.
Results: There were 111 patients in group 1, 96 patients in group 2, and 131 in group 3. The mortality rates were 21.6%, 35.4%, and 51.9% respectively. Univariate analysis revealed the mortality differences to be statistically significant. Multivariate logistic regression demonstrated higher odds of death with higher lactate tier group, however the findings did not reach statistical significance.
Conclusion: This study found that only assignment to group 3, initial lactic acid level of ≥ 4 mmol/L, was independently associated with increased mortality after correcting for underlying severity of illness and organ dysfunction. However, rising lactate levels in the other two groups were associated with increased severity of illness and were inversely proportional to prognosis.
Competing Interests: Conflicts of interest: None of the authors have any conflicts of interest as it pertains to this work. PD receives grant funding, which goes to his institution, from Vapotherm Inc.
Databáze: MEDLINE
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