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Lactate clearance as a simple bedside instrument to predict short-term mortality of severe septic patients
- Published: 27 October 2011
Keywords
- Severe Sepsis
- Confounder Variable
- Lactate Level
- Major Health Problem
- Vasoactive Drug
Introduction
Severe sepsis is major health problem with a high mortality rate, and still its incidence continues to rise [1–5]. Lactate clearance, measurement of the lactate level at two consecutive times, is an inexpensive and simple clinical parameter that can be obtained by a minimally invasive means [6–8]. This parameter represents kinetic alteration of the anaerobic metabolism that makes it a potential parameter to evaluate disease severity and intervention adequacy. Lactate clearance early in the hospital course may indicate a resolution of global tissue hypoxia and is associated with improved outcome [7–9]. Nevertheless, the relationship between lactate clearance and short-term mortality in severe septic patients is still poorly understood. Understanding the presence of confounder factors is also important to strengthen the role of lactate clearance in the treatment of severe septic patients.
Objective
To evaluate the clinical course between lactate clearance groups, and determine the role of confounder variables that influence its relationship.
Methods
This is a prospective cohort study conducted in Ciptomangun-kusumo Hospital, from March to May 2011. Patients were categorized into the high lactate clearance group if there were differences in 6-hour lactate levels ≥10%, and conversely were categorized into the low lactate clearance group [7, 8]. Deaths were observed within the first 10 days. After data collection, the statistical methods were analyzed using survival analysis. Analysis of confounder variables was performed by multivariate Cox regression test.
Results
Kaplan-Meier curves between lactate clearance groups.
Variables that potentially act as confounder factors
Variable | Nonsurvivors | Survivors | Pvalue | Adjusted HR (95% CI) | HR change (%) |
---|---|---|---|---|---|
Septic shock within 6 hours | |||||
With septic shock | 11 | 4 | 0.081 | 3.083 (1.505 to 6.317) | 7.4 |
Without septic shock | 23 | 22 | |||
Initial SOFA score | |||||
>9 | 11 | 3 | 0.038 | 2.919 (1.388 to 6.138) | 1.7 |
≤9 | 19 | 21 | |||
Vasoactive drugs within 6 hours | |||||
Without vasoactive drugs | 22 | 23 | 0.013 | 2.988 (1.462 to 6.106) | 4.1 |
With vasoactive drugs | 12 | 3 | |||
Invasive ventilation within 6 hoursa | |||||
Without mechanical ventilation | 31 | 23 | 0.777 | - | - |
With mechanical ventilation | 3 | 3 | |||
PRC transfusion within 6 hours | |||||
Without transfusion | 29 | 25 | 0.069 | 3.077 (1.493 to 6.340) | 7.2 |
With transfusion | 5 | 1 | |||
Fluid resuscitation within 6 hours | |||||
<1,000 cm3 | 15 | 18 | 0.166 | 2.942 (1.444 to 5.994) | 2.5 |
≥1,000 cm3 | 19 | 8 |
Conclusion
Severe septic patients with high lactate clearance have a better survival rate compared with the low lactate clearance group, and its relationship is not influenced by the presence of confounder variables.
Declarations
Acknowledgements
The authors thank the nurses and administrative staff in the Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty Medicine, University of Indonesia for their assistance in this study.
Authors’ Affiliations
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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.