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Volume 15 Supplement 3

Sepsis 2011

  • Poster presentation
  • Open Access

Lactate clearance as a simple bedside instrument to predict short-term mortality of severe septic patients

  • 1,
  • 1, 2,
  • 1, 2,
  • 1,
  • 1, 2 and
  • 1, 2
Critical Care201115 (Suppl 3) :P43

https://doi.org/10.1186/cc10412

  • Published:

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 [15]. 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 [68]. 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 [79]. 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

During the research period there were 60 patients recruited, consisting of 30 patients grouped into high lactate clearance and the remainder grouped into low lactate clearance. The survival rates in high and low lactate clearance groups were 60.0% versus 26.7% (see Figure 1). In the low lactate clearance group the median survival was 3 days, while the mortality rate did not reach 50% in the high lactate clearance group. The first interquartile was 1 day and 4 days. The hazard ratio between groups was 2.87 (95% CI = 1.41 to 5.83). Steps taken to analyze the role of variables that potentially act as confounder factors were by using bivariate analysis, in which variables that influenced the occurrence of deaths (indicated by P < 0.25) underwent multivariate analysis subsequently. On multivariate analysis the presence of septic shock, degree of organ dysfunction, vasoactive drug usage, blood transfusion, and fluid resuscitation change the hazard ratio by no more than 10% (Table 1). For that reason, these parameters were not considered as confounders.
Figure 1
Figure 1

Kaplan-Meier curves between lactate clearance groups.

Table 1

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

   

HR, hazard ratio; SOFA, Sequential Organ Failure Assessment; PRC, packed red cells. aInvasive ventilation parameter not included in multivariate analysis, because P < 0.25.

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

(1)
Internal Medicine Department, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
(2)
The Indonesian Society for the Study of Tropical Medicine and Infectious Diseases, Jakarta, Indonesia

References

  1. Moss M: Epidemiology of sepsis: race, sex, and chronic alcohol abuse. Clin Infect Dis. 2005, 41 (Suppl 7): S490-S497.View ArticlePubMedGoogle Scholar
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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

Copyright

© Hambali et al. 2011

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.

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