Kimberly A Chambers1, Adam Y Park2, Rosa C Banuelos2, Bryan F Darger3, Bindu H Akkanti4, Annamaria Macaluso5, Manoj Thangam6, Pratik B Doshi1,2,4. 1. Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA. 2. McGovern Medical School at UTHealth, Houston, TX, USA. 3. Department of Emergency Medicine, University of California, San Francisco, CA, USA. 4. Division of Critical Care, Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA. 5. Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA. 6. Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA.
Abstract
BACKGROUND: In the setting of severe sepsis and septic shock, mortality increases when lactate levels are ≥ 4 mmol/L. However, the consequences of lower lactate levels in this population are not well understood. The study aimed to determine the in-hospital mortality associated with severe sepsis and septic shock when initial lactate levels are < 4 mmol/L. METHODS: This is a retrospective cohort study of septic patients admitted over a 40-month period. Totally 338 patients were divided into three groups based on initial lactate values. Group 1 had lactate levels < 2 mmol/L; group 2: 2-4 mmol/L; and group 3: ≥ 4 mmol/L. The primary outcome was in-hospital mortality. RESULTS: There were 111 patients in group 1, 96 patients in group 2, and 131 in group 3. The mortality rates were 21.6%, 35.4%, and 51.9% respectively. Univariate analysis revealed the mortality differences to be statistically significant. Multivariate logistic regression demonstrated higher odds of death with higher lactate tier group, however the findings did not reach statistical significance. CONCLUSION: This study found that only assignment to group 3, initial lactic acid level of ≥ 4 mmol/L, was independently associated with increased mortality after correcting for underlying severity of illness and organ dysfunction. However, rising lactate levels in the other two groups were associated with increased severity of illness and were inversely proportional to prognosis.
BACKGROUND: In the setting of severe sepsis and septic shock, mortality increases when lactate levels are ≥ 4 mmol/L. However, the consequences of lower lactate levels in this population are not well understood. The study aimed to determine the in-hospital mortality associated with severe sepsis and septic shock when initial lactate levels are < 4 mmol/L. METHODS: This is a retrospective cohort study of septicpatients admitted over a 40-month period. Totally 338 patients were divided into three groups based on initial lactate values. Group 1 had lactate levels < 2 mmol/L; group 2: 2-4 mmol/L; and group 3: ≥ 4 mmol/L. The primary outcome was in-hospital mortality. RESULTS: There were 111 patients in group 1, 96 patients in group 2, and 131 in group 3. The mortality rates were 21.6%, 35.4%, and 51.9% respectively. Univariate analysis revealed the mortality differences to be statistically significant. Multivariate logistic regression demonstrated higher odds of death with higher lactate tier group, however the findings did not reach statistical significance. CONCLUSION: This study found that only assignment to group 3, initial lactic acid level of ≥ 4 mmol/L, was independently associated with increased mortality after correcting for underlying severity of illness and organ dysfunction. However, rising lactate levels in the other two groups were associated with increased severity of illness and were inversely proportional to prognosis.
Authors: Bogdan Tiru; Ernest K DiNino; Abigail Orenstein; Patrick T Mailloux; Adam Pesaturo; Abhinav Gupta; William T McGee Journal: Pharmacoeconomics Date: 2015-09 Impact factor: 4.981
Authors: Andrea Freyer Dugas; Julie Mackenhauer; Justin D Salciccioli; Michael N Cocchi; Shiva Gautam; Michael W Donnino Journal: J Crit Care Date: 2012-03-21 Impact factor: 3.425
Authors: Donald M Yealy; John A Kellum; David T Huang; Amber E Barnato; Lisa A Weissfeld; Francis Pike; Thomas Terndrup; Henry E Wang; Peter C Hou; Frank LoVecchio; Michael R Filbin; Nathan I Shapiro; Derek C Angus Journal: N Engl J Med Date: 2014-03-18 Impact factor: 91.245
Authors: Mitchell M Levy; Mitchell P Fink; John C Marshall; Edward Abraham; Derek Angus; Deborah Cook; Jonathan Cohen; Steven M Opal; Jean-Louis Vincent; Graham Ramsay Journal: Crit Care Med Date: 2003-04 Impact factor: 7.598
Authors: Stephen Trzeciak; R Phillip Dellinger; Michael E Chansky; Ryan C Arnold; Christa Schorr; Barry Milcarek; Steven M Hollenberg; Joseph E Parrillo Journal: Intensive Care Med Date: 2007-03-13 Impact factor: 17.440
Authors: Harith Alataby; Jay Nfonoyim; Keith Diaz; Amna Al-Tkrit; Shahnaz Akhter; Sharoon David; Vishnuveni Leelaruban; Kara S Gay-Simon; Vedatta Maharaj; Bruce Colet; Cherry Hanna; Cheryl-Ann Gomez Journal: Med Sci Monit Basic Res Date: 2021-02-01