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

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Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock. / Lokhandwala, Sharukh; Andersen, Lars W.; Nair, Sunil; Patel, Parth; Cocchi, Michael N.; Donnino, Michael W.

I: Journal of Critical Care, Bind 37, 02.2017, s. 179-184.

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

Harvard

Lokhandwala, S, Andersen, LW, Nair, S, Patel, P, Cocchi, MN & Donnino, MW 2017, 'Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock', Journal of Critical Care, bind 37, s. 179-184. https://doi.org/10.1016/j.jcrc.2016.09.023

APA

Lokhandwala, S., Andersen, L. W., Nair, S., Patel, P., Cocchi, M. N., & Donnino, M. W. (2017). Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock. Journal of Critical Care, 37, 179-184. https://doi.org/10.1016/j.jcrc.2016.09.023

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MLA

Vancouver

Author

Lokhandwala, Sharukh ; Andersen, Lars W. ; Nair, Sunil ; Patel, Parth ; Cocchi, Michael N. ; Donnino, Michael W. / Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock. I: Journal of Critical Care. 2017 ; Bind 37. s. 179-184.

Bibtex

@article{e9259433200b4790801e748e71ef414a,
title = "Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock",
abstract = "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{\%}, PConclusions: 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.",
keywords = "Sepsis, Lactate, Mortality, Sensitivity, Specificity, BLOOD LACTATE, CARDIAC-ARREST, SERUM LACTATE, MULTICENTER, CLEARANCE, INFECTION, THERAPY, TRIAL",
author = "Sharukh Lokhandwala and Andersen, {Lars W.} and Sunil Nair and Parth Patel and Cocchi, {Michael N.} and Donnino, {Michael W.}",
year = "2017",
month = "2",
doi = "10.1016/j.jcrc.2016.09.023",
language = "English",
volume = "37",
pages = "179--184",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "W.B. Saunders Co.",

}

RIS

TY - JOUR

T1 - Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock

AU - Lokhandwala, Sharukh

AU - Andersen, Lars W.

AU - Nair, Sunil

AU - Patel, Parth

AU - Cocchi, Michael N.

AU - Donnino, Michael W.

PY - 2017/2

Y1 - 2017/2

N2 - 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%, PConclusions: 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.

AB - 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%, PConclusions: 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.

KW - Sepsis

KW - Lactate

KW - Mortality

KW - Sensitivity

KW - Specificity

KW - BLOOD LACTATE

KW - CARDIAC-ARREST

KW - SERUM LACTATE

KW - MULTICENTER

KW - CLEARANCE

KW - INFECTION

KW - THERAPY

KW - TRIAL

U2 - 10.1016/j.jcrc.2016.09.023

DO - 10.1016/j.jcrc.2016.09.023

M3 - Journal article

VL - 37

SP - 179

EP - 184

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

ER -