Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock

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• 作者：Sharukh Lokhandwala ; MD^a ; ^b ; ^c ; ^d ; ^{slokhand@uw.edu} ; Lars W. Andersen ; MD ; MPH^e ; ^f ; ^g ; ^{lwanders@bidmc.harvard.edu} ; Sunil Nair ; MD^a ; ^b ; ^{ssnair@bidmc.harvard.edu} ; Parth Patel ; BS^e ; ^{pvpatel@bidmc.harvard.edu} ; Michael N. Cocchi ; MD^b ; ^e ; ^h ; ^{mcocchi@bidmc.harvard.edu} ; Michael W. Donnino ; MD^b ; ^e ; ⁱ ; ^{mdonnino@bidmc.harvard.edu}
• 关键词：Sepsis ; Lactate ; Mortality ; Sensitivity ; Specificity
• 刊名：Journal of Critical Care
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：37
• 期：Complete
• 页码：179-184
• 全文大小：420 K
• 卷排序：37

文摘

Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4 mmol/L, we compared mortality prediction between a subsequent lactate ≥4 mmol/L to a <10% and <20% decrease between initial and subsequent lactate values.Materials and methodsWe performed a single-center retrospective study of patients presenting to the emergency department with an initial lactate ≥4 mmol/L and suspected infection. Patients were stratified by lactate reduction using 3 previously identified definitions (subsequent lactate ≥4 mmol/L, and <10% and <20% relative decrease in lactate) and compared using multivariable logistic regression. Sensitivity and specificity were compared using McNemar test.ResultsA subsequent lactate ≥4 mmol/L and a lactate reduction <20% were associated with increased in-hospital mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.24-8.16; P = .02 and OR, 3.11; 95% CI, 1.39-6.96; P = .006, respectively), whereas a lactate reduction <10% was not (OR, 1.13; 95% CI, 0.94-1.34; P = .11). A subsequent lactate ≥4 mmol/L and a lactate reduction <20% were more sensitive than a lactate reduction <10% (72% vs 41%, P = .002 and 62% vs 41%, P = .008, respectively) but less specific (57% vs 76%, P < .001 and 67% vs 76%, P = .002, respectively).ConclusionsA subsequent lactate ≥4 mmol/L and lactate reduction <20% were associated with increased in-hospital mortality, whereas a lactate reduction <10% was not. Sensitivity and specificity are different between these parameters.