Skip to main content

Volume 3 Supplement 1

ESICM LIVES 2015

  • Poster presentation
  • Open access
  • Published:

Serial absolute lactate value < 4 versus relative 10% reduction as a predictor of mortality in severe sepsis and septic shock

Introduction

Serial lactate measurements provide a valuable tool to risk-stratify patients, determine the presence of ongoing tissue hypoperfusion, and potentially evaluate efficacy of therapeutic interventions. Prior studies have shown lactate clearance to be a valuable predictor of patient outcomes, however some have defined adequate change in lactate by a decrease from baseline by 10% whereas others considered an absolute reduction to lactate < 4mmol/L. We hypothesize that a serial absolute lactate < 4mmol/L after initial resuscitation will be as effective a predictor of future mortality as a change by 10%.

Objectives

To compare the diagnostic characteristics of an absolute serial lactate < 4 mmol/L after resuscitation with the more traditional definition (>10% decrease in serum lactate).

Methods

Single-center retrospective study of patients presenting to an urban tertiary care Emergency Department (ED) with lactate >4mmol/L and suspected infection. Continuous data was analyzed using a one-way ANOVA, whereas categorical data was compared using Fisher's exact test. Patients were stratified by lactate clearance using the traditional definition (>10% decrease in serum lactate) as well as a novel definition (second lactate < 4mmol/L) and compared.

Results

Median initial lactate was 5.2mmol/L [IQR 4.4-6.8]. The average decrease in serum lactate was 26.7% [2.3-44.4]. In-hospital mortality was 26.7%. 109/161 (67.7%) patients had >10% decrease in serum lactate, whereas 76/161 (47.2%) cleared lactate to < 4mmol/L. The average amount of crystalloid fluid resuscitation received was 2,970 ml, and the average time between lactate values was 181 minutes. Among patients who cleared lactate by at least 10%, mortality was 21.1% while those who did not clear their lactate by 10% had 38.5% mortality (p = 0.02). The negative predictive value for in-hospital mortality among those who clear their lactate by 10% was 78.9% [95% CI 69.8-85.9], sensitivity was 46.5% [95% CI: 31.5-62.2] and specificity was 72.9% [95% CI: 63.8-80.5]. Among patients who cleared their lactate to < 4mmol/L, mortality was 14.5%, while those who did not clear their lactate to < 4mmol/L had a mortality of 37.6% (p = 0.001). The negative predictive value for in-hospital mortality among those who clear lactate to < 4mmol/L was 85.5% [95% CI 75.2-92.2], sensitivity was 74.4% [58.5-86.0] and specificity was 55.1% [45.7-64.2].

Conclusions

A serial lactate < 4mmol/L as compared to >10% change has improved negative predictive value for in-hospital mortality and may provide more utility for risk stratification, assessment of response to therapy, and potentially clinical decision-making.

Grant Acknowledgment

Dr. Donnino, the Primary Investigator, is supported by NHLBI 1K02HL107447-01A1 and Dr. Cocchi is supported by AHA 15SDG22420010.

Table 1 Baseline Characteristics
Table 2 Comparison based on Lactate Clearance

Author information

Authors and Affiliations

Authors

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lokhandwala, S., Patel, P., Cocchi, M. et al. Serial absolute lactate value < 4 versus relative 10% reduction as a predictor of mortality in severe sepsis and septic shock. ICMx 3 (Suppl 1), A359 (2015). https://doi.org/10.1186/2197-425X-3-S1-A359

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/2197-425X-3-S1-A359

Keywords