Lactate clearance and mortality in septic patients with hepatic dysfunction

ABSTRACT Background Serum lactate clearance (LC) during initial resuscitation is a potentially useful prognostic marker in patients with severe sepsis or septic shock. However, it is unclear whether LC is also associated with the outcome in septic patients with hepatic dysfunction that may impair lactate elimination, which may contribute to elevated serum lactate levels or decreased LC. Methods The relationships between LC measured within 6 and 24 hours after initial resuscitation and hospital mortality were evaluated with multiple logistic regression analysis. Results Of 770 patients with severe sepsis or septic shock, 208 (27%) with hepatic dysfunction were included in the analysis. The median LC within 6 hours in survivors (31.4%) was significantly higher than that of non-survivors (9.3%) ( P = .010). In addition, the median LC within 24 hours was also significantly different between groups (51% vs. 12%, P < .001). Low LCs, defined as less than 10% of clearance, at 6 and 24 hours were associated with in-hospital mortality. After adjusting for potential confounding factors, low LCs at 6 and 24 hours remained associated with hospital mortality (adjusted OR 4.940, 95% CI 1.762 – 13.854 at 6 hours; adjusted OR 5.997. 95% CI 2.149 – 16.737 at 24 hours). However, LC at 24 hours (AUC of 0.704) had higher discriminatory power to predict hospital mortality than LC at 6 hours (AUC of 0.608) ( P = .033). Conclusions LC may be useful for predicting outcomes in septic patients with hepatic dysfunction.