Skip to main content

Advertisement

You are viewing the new article page. Let us know what you think. Return to old version

Lactate index and survival in hospital-acquired septic shock

Introduction

Severe sepsis is characterised by profound metabolic and inflammatory derangement, which can lead to multiorgan failure and death. During septic shock, oxygen delivery may fail to meet tissue demand resulting in increased oxygen extraction. Once tissue needs are no longer met, an oxygen debt with global tissue hypoxia and associated hyperlactataemia ensues. Several studies have shown that blood lactate may be used as a marker of global tissue hypoxia and prognosis in shock states.

Methods

Forty patients requiring adrenaline therapy for a first episode of septic shock acquired >24 hours after admission to the ICU had blood lactate levels measured 2-hourly over a 24-hour period. Adrenaline therapy was escalated until the target mean arterial pressure was reached. The lactate index was calculated as the ratio of maximum lactate increase to the adrenaline increase.

Results

Lactate increased from 2.3 to 2.9 mmol/l (P = 0.024) and the mean adrenaline increase was 0.14 μg/kg/minute. Peak lactate correlated with peak adrenaline (rho = 0.34, P = 0.032). Lactate index was the only independent predictor of survival after controlling for age and APACHE II score (OR = 1.14, 95% CI = 1.03 to 1.26, P = 0.009).

Conclusions

A high lactate following adrenaline administration may be a beneficial and appropriate response.

References

  1. 1.

    Huckabee WE: Abnormal resting blood lactate. I. The significance of hyperlactatemia in hospitalized patients. Am J Med 1961, 30: 840-848.

  2. 2.

    Vitek V, Cowley RA: Blood lactate in the prognosis of various forms of shock. Ann Surg 1971, 173: 308-313.

  3. 3.

    Cowan BN, Burns HJ, Boyle P, Ledingham IM: The relative prognostic value of lactate and haemodynamic measurements in early shock. Anaesthesia 1984, 39: 750-755.

  4. 4.

    Levy B, Gibot S, Franck P, Cravoisy A, Bollaert PE: Relation between muscle Na+K+ATPase activity and raised lactate concentrations in septic shock: a prospective study. Lancet 2005, 365: 871-875.

  5. 5.

    Leverve XM, Mustafa I: Lactate: a key metabolite in the intercellular metabolic interplay. Crit Care 2002, 6: 284-285.

  6. 6.

    Bassi G, Radermacher P, Calzia E: Catecholamines and vasopressin during critical illness. Endocrinol Metab Clin North Am 2006, 35: 839-857.

Download references

Author information

Correspondence to S Omar.

Rights and permissions

Reprints and Permissions

About this article

Keywords

  • Lactate
  • Adrenaline
  • Septic Shock
  • Severe Sepsis
  • Blood Lactate