Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Sharukh Lokhandwala, Univ Washington, University of Washington, University of Washington Seattle, Div Pulm & Crit Care, Dept Med
  • ,
  • Lars W. Andersen
  • Sunil Nair, Harvard Med Sch, Harvard University, Dept Hlth Care Policy
  • ,
  • Parth Patel
  • ,
  • Michael N. Cocchi, Beth Israel Deaconess Med Ctr, VA Boston Healthcare System, Harvard University, Div Crit Care, Dept Anesthesia Crit Care
  • ,
  • Michael W. Donnino, Beth Israel Deaconess Med Ctr, VA Boston Healthcare System, Harvard University, Dept Med, Div Pulm & Crit Care

Purpose: Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >= 4 mmol/L, we compared mortality prediction between a subsequent lactate > 4 mmol/L to a <10% and <20% decrease between initial and subsequent lactate values.

Materials and methods: We performed a single-center retrospective study of patients presenting to the emergency department with an initial lactate >= 4 mmol/L and suspected infection. Patients were stratified by lactate reduction using 3 previously identified definitions (subsequent lactate >= 4 mmol/L, and <10% and <20% relative decrease in lactate) and compared using multivariable logistic regression. Sensitivity and specificity were compared using McNemar test.

Results: A subsequent lactate >= 4 mmol/L and a lactate reduction <20% were associated with increased in-hospital mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.24-8.16; P=.02 and OR, 3.11; 95% CI, 1.39-6.96; P =. 006, respectively), whereas a lactate reduction b10% was not (OR, 1.13; 95% CI, 0.94-1.34; P =.11). A subsequent lactate = 4mmol/L and a lactate reduction <20% were more sensitive than a lactate reduction b10% (72% vs 41%, P =.002 and 62% vs 41%, P =.008, respectively) but less specific (57% vs 76%, P

Conclusions: A subsequent lactate = 4 mmol/L and lactate reduction <20% were associated with increased in hospital mortality, whereas a lactate reduction <10% was not. Sensitivity and specificity are different between these parameters. (C) 2016 Elsevier Inc. All rights reserved.

OriginalsprogEngelsk
TidsskriftJournal of Critical Care
Vol/bind37
Sider (fra-til)179-184
Antal sider6
ISSN0883-9441
DOI
StatusUdgivet - feb. 2017

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