Blood lactate levels and/or norepinephrine requirements for risk stratification in sepsis
© Cortés et al. 2015
Published: 28 September 2015
Recent large multicenter studies on early resuscitation protocols for sepsis in the emergency room (ER) have shown a mortality rate of 19 % in the control groups [1, 2]. These results suggest that the strategies used to include patients in these studies (high lactate or use of norepinephrine) did not identify a population at high risk of mortality. We explored the prognostic values of these criteria in an ICU population.
All admissions to our department of intensive care in 2013 were retrospectively screened to identify patients who had an initial elevated lactate (≥2 mEq/l) or needed norepinephrine infusion (group OR) vs. those who had an initial elevated lactate and needed norepinephrine infusion (group AND) during the first 24 hours. We then classified the groups by the presence of sepsis at admission or not. The analysis was repeated using a lactate threshold of ≥4 mEq/l. We collected relevant demographic and clinical data including the type of admission, data needed to calculate the sequential organ failure assessment (SOFA) score, and ICU mortality. All values are presented as proportions or median values (percentiles 25-75).
Mortality in our septic population was higher than that reported in recent randomized controlled trials for early sepsis resuscitation in the ER [1, 2], limiting the external validity of these trial results to other ICU populations. Mortality was higher when hyperlactatemia and need for norepinephrine were present simultaneously compared with the presence of only one of these two criteria.
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