Lactate Profile Assessment—A Good Predictor of Prognosis in Patients with COVID-19 and Septic Shock Requiring Continuous Renal Therapy

Autor: Cosmin Iosif Trebuian, Adina Maria Marza, Raul Chioibaş, Dumitru Şutoi, Alina Petrica, Iulia Crintea-Najette, Daian Popa, Florin Borcan, Daniela Flondor, Ovidiu Alexandru Mederle
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Clinics and Practice, Vol 14, Iss 3, Pp 980-994 (2024)
Druh dokumentu: article
ISSN: 2039-7283
DOI: 10.3390/clinpract14030078
Popis: Introduction: Lactate is a useful prognostic marker, as its level increases in hypoxic tissue and/or during accelerated aerobic glycolysis due to excessive beta-adrenergic stimulation and decreased lactate clearance. The Surviving Sepsis Campaign Bundle 2018 Update suggests premeasurement of lactate within 2–4 h so that physicians perform, assist, administer, and introduce lactate-guided resuscitation to reduce mortality due to sepsis. Methods: A total of 108 patients with septic shock who underwent continuous renal replacement therapy (CRRT) for acute kidney injury were enrolled in this observational study. Demographic, clinical, and laboratory data were collected, and patients were divided into two groups: survivors and non-survivors. Results: Multivariate analysis demonstrated that lactate levels at 24 h after initiation of CRRT treatment, but not lactate levels at intensive care unit (ICU) admission, were associated with mortality. Lactate clearance was associated with lower mortality among the survivors (OR = 0.140) at 6 h after ICU admission and late mortality (OR = 0.260) after 24 h. The area under the ROC curves for mortality was 0.682 for initial lactate; 0.797 for lactate at 24 h; and 0.816 for lactate clearance at 24 h. Conclusions: Our result reinforces that the determination of lactate dynamics represents a good predictor for mortality, and serial lactate measurements may be more useful prognostic markers than initial lactate in patients with septic shock.
Databáze: Directory of Open Access Journals
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