Khrongwong Musikatavorn1, Saranpat Thepnimitra2, Atthasit Komindr3, Patima Puttaphaisan4, Dhanadol Rojanasarntikul5. 1. Emergency Medicine Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok 10330, Thailand. Electronic address: khrongwong.m@chulahospital.org. 2. Emergency Medicine Unit, Outpatient Department, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok 10330, Thailand. Electronic address: docpup9@hotmail.com. 3. Emergency Medicine Unit, Outpatient Department, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok 10330, Thailand. Electronic address: andykrub@gmail.com. 4. Emergency Medicine Unit, Outpatient Department, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok 10330, Thailand. Electronic address: patiputt@gmail.com. 5. Emergency Medicine Unit, Outpatient Department, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok 10330, Thailand. Electronic address: na_nadol@hotmail.com.
Abstract
OBJECTIVES: Our study aims to investigate the role of initial venous lactate in predicting the probability of clinical deterioration and 30-day mortality in nonelderly sepsis patients with acute infections, without hemodynamic shock. METHODS: We enrolled emergency department patients aged 18 to 65 years with acute major infections, but without organ hypoperfusion, and obtained a single venous lactate measurement at initial presentation. As the primary end point, the eligible patients were tracked for the need for vasopressor or mechanical ventilation (MV) in the next 72 hours. The patients' venous lactate and related risk factors were analyzed. We also followed the cohort and the predictors to investigate their prognostic role for 30-day mortality. RESULTS: Of 392 patients, 74 required vasopressor/MV, and 388 patients were available for mortality analysis. An initial lactate greater than or equal to 2 mmol/L was the strongest independent predictor for the requirement of vasopressor/MV (adjusted odds ratio, 6.2; 95% confidence interval, 3.4-11.3). The other independent risk factors were immunosuppressive drug users and positive blood culture. However, the initial lactate was not associated with 30-day mortality. The factors that were associated with mortality were the use of vasopressor/MV, active malignancy, Rapid Emergency Medicine Score greater than or equal to 6, and hospitalization within 90 days. CONCLUSIONS: In nonelderly sepsis patients with stable hemodynamic, elevated venous lactate (≥2 mmol/L) was associated with an increased probability of the need for vasopressor/MV. However, unfavorable medical histories and the severity of physiologic changes may be associated with short-term mortality to a greater extent than the single value of initial lactate.
OBJECTIVES: Our study aims to investigate the role of initial venous lactate in predicting the probability of clinical deterioration and 30-day mortality in nonelderly sepsispatients with acute infections, without hemodynamic shock. METHODS: We enrolled emergency department patients aged 18 to 65 years with acute major infections, but without organ hypoperfusion, and obtained a single venous lactate measurement at initial presentation. As the primary end point, the eligible patients were tracked for the need for vasopressor or mechanical ventilation (MV) in the next 72 hours. The patients' venous lactate and related risk factors were analyzed. We also followed the cohort and the predictors to investigate their prognostic role for 30-day mortality. RESULTS: Of 392 patients, 74 required vasopressor/MV, and 388 patients were available for mortality analysis. An initial lactate greater than or equal to 2 mmol/L was the strongest independent predictor for the requirement of vasopressor/MV (adjusted odds ratio, 6.2; 95% confidence interval, 3.4-11.3). The other independent risk factors were immunosuppressive drug users and positive blood culture. However, the initial lactate was not associated with 30-day mortality. The factors that were associated with mortality were the use of vasopressor/MV, active malignancy, Rapid Emergency Medicine Score greater than or equal to 6, and hospitalization within 90 days. CONCLUSIONS: In nonelderly sepsispatients with stable hemodynamic, elevated venous lactate (≥2 mmol/L) was associated with an increased probability of the need for vasopressor/MV. However, unfavorable medical histories and the severity of physiologic changes may be associated with short-term mortality to a greater extent than the single value of initial lactate.
Authors: A F Peschka; S Kaestle; F Seidel; L Weidhase; M Bernhard; A Gries; S Petros Journal: Med Klin Intensivmed Notfmed Date: 2018-07-26 Impact factor: 0.840