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Volume 17 Supplement 4

Sepsis 2013

Open Access

Serum arterial lactate at the time of admission as a predictor of mortality in patients admitted with severe sepsis and septic shock to an ICU

  • Adriell Ramalho Santana1,
  • Fábio Ferreira Amorim1,
  • Bárbara Magalhães Menezes1,
  • Felipe Bozi Soares1,
  • Fernanda Vilas Bôas Araújo1,
  • Jacqueline Lima de Souza1,
  • Mariana Pinheiro Barbosa de Araújo1,
  • Louise Cristhine de Carvalho Santos1,
  • Pedro Henrique Gomes Rocha1,
  • Osvaldo Gonçalves da Silva Neto1,
  • Guilherme Menezes de Andrade Filho1,
  • Pedro Nery Ferreira Júnior1,
  • Alethea Patrícia Pontes Amorim2,
  • Rodrigo Santos Biondi3 and
  • Rubens Antônio Bento Ribeiro3
Critical Care201317(Suppl 4):P47

https://doi.org/10.1186/cc12947

Published: 5 November 2013

Keywords

LactateSeptic ShockSevere SepsisHospital MortalityRetrospective Cohort Study

Background

Elevated serum arterial lactate levels are often associated with an imbalance between oxygen demand and delivery, which has a strong correlation with poorer outcomes in critically ill patients [1, 2]. This study aims to evaluate serum arterial lactate as a predictor of mortality in critical patients admitted with severe sepsis and septic shock.

Materials and methods

Retrospective cohort study conducted in the ICU of Hospital Anchieta, Brasília, DF, Brazil, during 3 years. For the first analysis, patients were divided into two groups: group with arterial lactate >2 mmol/l and group with low arterial lactate ≤2 mmol/l at the time of admission. For a second analysis, patients were divided into two groups: group with arterial lactate >3.3 mmol/l and group with arterial lactate ≤3.3 mmol/l at the time of admission.

Results

A total of 195 patients with sepsis were enrolled, 41% (n = 80) with septic shock. Mean age was 63 ± 22 years, ICU length of stay 9 ± 11 days, SAPS3 62 ± 16, and APACHE II 21 ± 9. ICU mortality in 4 days was 10.8% (n = 21), in 28 days was 12.3% (n = 24), and hospital mortality was 26.2% (n = 51). The nonsurvivor patients had higher lactate values (2.0 ± 1.4 vs. 1.3 ± 1.1, P = 0.00). Considering the arterial lactate cutoff value of 2.0 mmol/l, there was no difference between groups regarding ICU length of stay (10 ± 13 vs. 9 ± 2 days, P = 0.47), mortality in 4 days (12% vs. 10%, P = 0.85), mortality in 28 days (13% vs. 16%, P = 0.77), and hospital mortality (30% vs. 32%, P = 0.86). However, considering the lactate cutoff value of 3.3 mmol/l, the high lactate group had higher mortality in 4 days (27% vs. 9%, P = 0.04) and hospital mortality (67% vs. 23%, P = 0.00). There was no statistical significant difference regarding mortality in 28 days (27% vs. 11%, P = 0.08), and ICU length of stay (8 ± 7 vs. 9 ± 11 days, P = 0.59). The relative risk of hospital death in patients with arterial lactate >3.3 mmol/l was 2.93 (95% CI: 1.87 to 4.58). The specificity of arterial lactate >3.3 mmol/l for hospital mortality was 96.5% (95% CI: 92.1 to 98.5%), sensibility was 19.6% (95% CI: 11.0 to 32.5%), and LR+ was 5.65 (95% CI: 2.03 to 15.7%). The arterial lactate area under the ROC curve for mortality was 0.634 (95% CI: 0.540 to 0.748).

Conclusions

In the patients admitted with severe sepsis and septic shock for this sample, the nonsurvivors had higher lactate values. Arterial lactate >2 mmol/l at the time of admission was not associated with mortality. Arterial lactate >3.3 mmol/l was associated with mortality in 4 days, and hospital mortality. Indeed, lactate >3.3 mmol/l had high specificity for hospital mortality.

Authors’ Affiliations

(1)
Escola Superior de Ciências da Saúde, Brasília, Brazil
(2)
Liga Acadêmica de Medicina Intensiva de Brasília, Brazil
(3)
Hospital Anchieta, Brasília, Brazil

References

  1. 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 and septic shock. Crit Care Med. 2004, 32: 1637-1642. 10.1097/01.CCM.0000132904.35713.A7.View ArticlePubMedGoogle Scholar
  2. Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, Willemsen SP, Bakker J, LACTATE Study Group: Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010, 182: 752-761. 10.1164/rccm.200912-1918OC.View ArticlePubMedGoogle Scholar

Copyright

© Santana et al.; licensee BioMed Central Ltd. 2013

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. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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