- Poster presentation
- Open Access
Lactate clearance as a simple bedside instrument to predict short-term mortality of severe septic patients
© Hambali et al. 2011
- Published: 27 October 2011
- Severe Sepsis
- Confounder Variable
- Lactate Level
- Major Health Problem
- Vasoactive Drug
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.
To evaluate the clinical course between lactate clearance groups, and determine the role of confounder variables that influence its relationship.
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.
Variables that potentially act as confounder factors
Adjusted HR (95% CI)
HR change (%)
Septic shock within 6 hours
With septic shock
3.083 (1.505 to 6.317)
Without septic shock
Initial SOFA score
2.919 (1.388 to 6.138)
Vasoactive drugs within 6 hours
Without vasoactive drugs
2.988 (1.462 to 6.106)
With vasoactive drugs
Invasive ventilation within 6 hoursa
Without mechanical ventilation
With mechanical ventilation
PRC transfusion within 6 hours
3.077 (1.493 to 6.340)
Fluid resuscitation within 6 hours
2.942 (1.444 to 5.994)
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.
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.
- Moss M: Epidemiology of sepsis: race, sex, and chronic alcohol abuse. Clin Infect Dis. 2005, 41 (Suppl 7): S490-S497.View ArticlePubMedGoogle Scholar
- Guidet B, Aegerter P, Gauzit R, Meshaka P, Dreyfuss D: Incidence and impact of organ dysfunctions associated with sepsis. Chest. 2005, 127: 942-951. 10.1378/chest.127.3.942.View ArticlePubMedGoogle Scholar
- O'brien JM, Ali NA, Abraham E: Year in review in critical care, 2004: sepsis and multi-organ failure. Crit Care. 2005, 9: 409-413. 10.1186/cc3728.PubMed CentralView ArticlePubMedGoogle Scholar
- Ely EW, Kleinpell RM, Goyette RE: Advances in the understanding of clinical manifestations and therapy of severe sepsis: an update for critical care nurses. Am J Crit Care. 2003, 12: 120-133.PubMedGoogle Scholar
- Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the united states: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001, 29: 1303-1310. 10.1097/00003246-200107000-00002.View ArticlePubMedGoogle Scholar
- Nguyen HB, Loomba M, Yang JJ, Jacobsen G, Shah K, Otero RM, Suarez A, Parekh H, Jaehne A, Rivers EP: Early lactate clearance is associated with biomarkers of inflammation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock. J Inflamm. 2010, 7: 6-17. 10.1186/1476-9255-7-6.View ArticleGoogle Scholar
- Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, Tomlanovich MC: Early lactate clearance is associated with improved outcome in severe sepsis & septic shock. Crit Care Med. 2004, 32: 1637-1642. 10.1097/01.CCM.0000132904.35713.A7.View ArticlePubMedGoogle Scholar
- Arnold RC, Shapiro NI, Jones AE, Schorr C, Pope J, Casner E, Parrillo JE, Dellinger P, Trzeciak S: Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock. 2009, 32: 35-39. 10.1097/SHK.0b013e3181971d47.View ArticlePubMedGoogle Scholar
- Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA: Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy. JAMA. 2010, 303: 739-746. 10.1001/jama.2010.158.PubMed CentralView ArticlePubMedGoogle Scholar
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.