Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: A retrospective cohort study according to the Sepsis-3 definitions
The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in pa...
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| Veröffentlicht in: | Medicine (Baltimore) 2021-02, Vol.100 (7), p.e24835-e24835 |
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| creator | Lee, Seong Geun Song, Juhyun Park, Dae Won Moon, Sungwoo Cho, Han-jin Kim, Joo Yeong Park, Jonghak Cha, Jae Hyung |
| description | The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics ( |
| doi_str_mv | 10.1097/MD.0000000000024835 |
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This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (<10%, <20%, and <30%) was evaluated. We compared the sensitivity and specificity between metrics.Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower 6-hour lactate clearance than those of survivors. Six-hour lactate levels and 6-hour lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097-1.294] and 0.989 [0.983-0.995], respectively). Six-hour lactate levels had better prognostic value than 6-hour lactate clearance (area under the curve, 0.720 [95% CI, 0.670-0.765] vs 0.656 [0.605-0.705]; P = .02). Six-hour lactate levels of ≥3.5 mmol/L and 6-hour lactate clearance of <24.4% were the optimal cut-off value in predicting the 30-day mortality. The prognostic value of 6-hour lactate metrics and 6-hour lactate clearance metrics did not differ. Six-hour lactate levels (≥2 mmol/L) had the highest sensitivity (89.2%).Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than 6-hour lactate clearance and initial lactate levels.</description><identifier>ISSN: 0025-7974</identifier><identifier>EISSN: 1536-5964</identifier><identifier>DOI: 10.1097/MD.0000000000024835</identifier><identifier>PMID: 33607851</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Biomarkers ; Case-Control Studies ; Emergency Service, Hospital ; Female ; Humans ; Hyperlactatemia - complications ; Lactic Acid - metabolism ; Lactic Acid - pharmacokinetics ; Male ; Metabolic Clearance Rate ; Middle Aged ; Observational Study ; Organ Dysfunction Scores ; Republic of Korea - epidemiology ; Resuscitation - standards ; Retrospective Studies ; Sensitivity and Specificity ; Sepsis - epidemiology ; Sepsis - metabolism ; Sepsis - mortality ; Shock, Septic - epidemiology ; Shock, Septic - metabolism ; Shock, Septic - mortality</subject><ispartof>Medicine (Baltimore), 2021-02, Vol.100 (7), p.e24835-e24835</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.</rights><rights>Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3550-6f79981b59374f1f9c3659625f9920a13f79dda384188a288934542a278487bf3</cites><orcidid>0000-0001-6217-7360</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899836/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899836/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33607851$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Seong Geun</creatorcontrib><creatorcontrib>Song, Juhyun</creatorcontrib><creatorcontrib>Park, Dae Won</creatorcontrib><creatorcontrib>Moon, Sungwoo</creatorcontrib><creatorcontrib>Cho, Han-jin</creatorcontrib><creatorcontrib>Kim, Joo Yeong</creatorcontrib><creatorcontrib>Park, Jonghak</creatorcontrib><creatorcontrib>Cha, Jae Hyung</creatorcontrib><title>Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: A retrospective cohort study according to the Sepsis-3 definitions</title><title>Medicine (Baltimore)</title><addtitle>Medicine (Baltimore)</addtitle><description>The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (<10%, <20%, and <30%) was evaluated. We compared the sensitivity and specificity between metrics.Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower 6-hour lactate clearance than those of survivors. Six-hour lactate levels and 6-hour lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097-1.294] and 0.989 [0.983-0.995], respectively). Six-hour lactate levels had better prognostic value than 6-hour lactate clearance (area under the curve, 0.720 [95% CI, 0.670-0.765] vs 0.656 [0.605-0.705]; P = .02). Six-hour lactate levels of ≥3.5 mmol/L and 6-hour lactate clearance of <24.4% were the optimal cut-off value in predicting the 30-day mortality. The prognostic value of 6-hour lactate metrics and 6-hour lactate clearance metrics did not differ. Six-hour lactate levels (≥2 mmol/L) had the highest sensitivity (89.2%).Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than 6-hour lactate clearance and initial lactate levels.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers</subject><subject>Case-Control Studies</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Humans</subject><subject>Hyperlactatemia - complications</subject><subject>Lactic Acid - metabolism</subject><subject>Lactic Acid - pharmacokinetics</subject><subject>Male</subject><subject>Metabolic Clearance Rate</subject><subject>Middle Aged</subject><subject>Observational Study</subject><subject>Organ Dysfunction Scores</subject><subject>Republic of Korea - epidemiology</subject><subject>Resuscitation - standards</subject><subject>Retrospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Sepsis - epidemiology</subject><subject>Sepsis - metabolism</subject><subject>Sepsis - mortality</subject><subject>Shock, Septic - epidemiology</subject><subject>Shock, Septic - metabolism</subject><subject>Shock, Septic - mortality</subject><issn>0025-7974</issn><issn>1536-5964</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdke1qFDEUhoModq1egSC5gan5nCT-EErrF7QoqL-HbObMTmx2MiTZXfa-vEDT3bp-hEDC-573OSQHoZeUXFBi1Ovb6wvyZzGhuXyEFlTytpGmFY_RoqqyUUaJM_Qs5x-EUK6YeIrOOG-J0pIu0M8vKa6mmIt3eGvDBnAccLCu2AI4wBZCxnbqT5ILYJOdHGA_4Qxz9ke_Xu8ReYzuDu98Gavvi7cBj_sZ0kN87e0bfIkTlBTzDK74bUXGMaaCc9n0e2ydi6n30wqXiMsI-OuhR8NxD8MBGaf8HD0ZbMjw4uE8R9_fv_t29bG5-fzh09XlTeO4lKRpB2WMpktpuBIDHYzjbf0ZJgdjGLGUV7_vLdeCam2Z1oYLKZhlSgutlgM_R2-P3HmzXEPvYCrJhm5Ofm3TvovWd_86kx-7Vdx2StfGvK0AfgS4-t6cYDhlKenuh9jdXnf_D7GmXv3d9pT5PbVaII4FuxgKpHwXNjtI3Qg2lPHAk8qwhhFG6zakqYoh_BeBGqu9</recordid><startdate>20210219</startdate><enddate>20210219</enddate><creator>Lee, Seong Geun</creator><creator>Song, Juhyun</creator><creator>Park, Dae Won</creator><creator>Moon, Sungwoo</creator><creator>Cho, Han-jin</creator><creator>Kim, Joo Yeong</creator><creator>Park, Jonghak</creator><creator>Cha, Jae Hyung</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6217-7360</orcidid></search><sort><creationdate>20210219</creationdate><title>Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: A retrospective cohort study according to the Sepsis-3 definitions</title><author>Lee, Seong Geun ; Song, Juhyun ; Park, Dae Won ; Moon, Sungwoo ; Cho, Han-jin ; Kim, Joo Yeong ; Park, Jonghak ; Cha, Jae Hyung</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3550-6f79981b59374f1f9c3659625f9920a13f79dda384188a288934542a278487bf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers</topic><topic>Case-Control Studies</topic><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Humans</topic><topic>Hyperlactatemia - complications</topic><topic>Lactic Acid - metabolism</topic><topic>Lactic Acid - pharmacokinetics</topic><topic>Male</topic><topic>Metabolic Clearance Rate</topic><topic>Middle Aged</topic><topic>Observational Study</topic><topic>Organ Dysfunction Scores</topic><topic>Republic of Korea - epidemiology</topic><topic>Resuscitation - standards</topic><topic>Retrospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Sepsis - epidemiology</topic><topic>Sepsis - metabolism</topic><topic>Sepsis - mortality</topic><topic>Shock, Septic - epidemiology</topic><topic>Shock, Septic - metabolism</topic><topic>Shock, Septic - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Seong Geun</creatorcontrib><creatorcontrib>Song, Juhyun</creatorcontrib><creatorcontrib>Park, Dae Won</creatorcontrib><creatorcontrib>Moon, Sungwoo</creatorcontrib><creatorcontrib>Cho, Han-jin</creatorcontrib><creatorcontrib>Kim, Joo Yeong</creatorcontrib><creatorcontrib>Park, Jonghak</creatorcontrib><creatorcontrib>Cha, Jae Hyung</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Medicine (Baltimore)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Seong Geun</au><au>Song, Juhyun</au><au>Park, Dae Won</au><au>Moon, Sungwoo</au><au>Cho, Han-jin</au><au>Kim, Joo Yeong</au><au>Park, Jonghak</au><au>Cha, Jae Hyung</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: A retrospective cohort study according to the Sepsis-3 definitions</atitle><jtitle>Medicine (Baltimore)</jtitle><addtitle>Medicine (Baltimore)</addtitle><date>2021-02-19</date><risdate>2021</risdate><volume>100</volume><issue>7</issue><spage>e24835</spage><epage>e24835</epage><pages>e24835-e24835</pages><issn>0025-7974</issn><eissn>1536-5964</eissn><abstract>The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (<10%, <20%, and <30%) was evaluated. We compared the sensitivity and specificity between metrics.Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower 6-hour lactate clearance than those of survivors. Six-hour lactate levels and 6-hour lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097-1.294] and 0.989 [0.983-0.995], respectively). Six-hour lactate levels had better prognostic value than 6-hour lactate clearance (area under the curve, 0.720 [95% CI, 0.670-0.765] vs 0.656 [0.605-0.705]; P = .02). Six-hour lactate levels of ≥3.5 mmol/L and 6-hour lactate clearance of <24.4% were the optimal cut-off value in predicting the 30-day mortality. The prognostic value of 6-hour lactate metrics and 6-hour lactate clearance metrics did not differ. Six-hour lactate levels (≥2 mmol/L) had the highest sensitivity (89.2%).Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than 6-hour lactate clearance and initial lactate levels.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>33607851</pmid><doi>10.1097/MD.0000000000024835</doi><orcidid>https://orcid.org/0000-0001-6217-7360</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Medicine (Baltimore), 2021-02, Vol.100 (7), p.e24835-e24835 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Wolters Kluwer Open Access; PubMed (Medline); IngentaConnect Backfiles; Alma/SFX Local Collection; EZB Electronic Journals Library |
| subjects | Aged Aged, 80 and over Biomarkers Case-Control Studies Emergency Service, Hospital Female Humans Hyperlactatemia - complications Lactic Acid - metabolism Lactic Acid - pharmacokinetics Male Metabolic Clearance Rate Middle Aged Observational Study Organ Dysfunction Scores Republic of Korea - epidemiology Resuscitation - standards Retrospective Studies Sensitivity and Specificity Sepsis - epidemiology Sepsis - metabolism Sepsis - mortality Shock, Septic - epidemiology Shock, Septic - metabolism Shock, Septic - mortality |
| title | Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: A retrospective cohort study according to the Sepsis-3 definitions |
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