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KMID : 0604020110260020078
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Korean Journal of Critical Care Medicine
2011 Volume.26 No. 2 p.78 ~ p.82
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Lactate Clearance and Outcome in Septic Shock Patients with Low Level of Initial Lactate
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Sim Yun-Su
Ham Cho-Rom
Lim So-Yeon
Suh Gee-Young
Jeon Kyeong-Man
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Abstract
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Background: Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis and septicshock. However, there are only a few studies on the association of serum lactate levels and prognosis in septicshock patients with initial low lactate levels.
Methods:To evaluate whether initial and follow-up lactate levels associated with mortality in septic shock patientswith low lactate level, we conducted a retrospective observational study of patients with septic shock, who were hospitalized through the emergency department in February-July 2008. Initial lactate level was stratified as low (＜4 mmol/L) or high (≥4 mmol/L). The primary outcome was 28-day mortality and multiple logistic regression analysis was used to adjust for potential confounders in the association between lactate clearance and mortality.
Results:Of 90 patients hospitalized with septic shock during the study period, 68 (76%) patients had low initial lactate. Mortality at 28 days was 18% in patients with low lactate level. In these patients, initial lactate level was not associated with mortality (p = 0.590). However, increased lactate at follow-up and lactate clearance were associated with mortality (p = 0.006, p = 0.002, respectively). In a multiple logistic regression analysis, increased mortality rate independently associated with age (OR 1.162, 95% CI 1.041-1.298) and lactate clearance (OR 0.654, 95% CI 0.498-0.859).
Conclusions :In septic shock patients with a low lactate level, lactate clearance independently associated with a decreased mortality rate. Therefore, lactate clearance could be useful for predicting the outcome in these patients.
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KEYWORD
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Lactic acid, mortality, prognosis, septic shock
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