A two-year cross-sectional study on the impact of serial serum Lactate in comparison with APACHE IV and SOFA Scores in predicting outcomes in patients of sepsis at limited resources rural setup

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Objectives: Lactic acid is a metabolite that is physiologically produced and metabolized in a balanced state in the body from glucose. Critically ill patients with sepsis are found to have higher serum lactate levels. In this study, the established Intensive Care Unit (ICU) scores that are Sequential Organ Failure Assessment (SOFA) and Acute physiology and chronic health evaluation (APACHE IV) were compared to serial serum lactate measurements as a superior predictor of mortality in critically ill patients with sepsis admitted under Intensive Care Unit. Methods: In this cross-sectional study, 280 patients who were admitted to ICU care and were diagnosed to have sepsis were enrolled from August 2019 to September 2021. The presentation of the categorical variables was done in the form of numbers and percentages (%). On the other hand, the quantitative data were presented as the means ± SD and as median with 25th and 75th percentiles (interquartile range). The data normality was checked by using the Kolmogorov-Smirnov test. In the cases in which the data was not normal, nonparametric tests were used. Results: An ICU mortality rate of 43.21% was observed among the 280 adult patients diagnosed with sepsis admitted to ICU involved in this study. The interpretation of the area under the Receiver operating curve (ROC) showed that the performance of serum Lactate (mmol/L) on day 3 (Area under the curve [AUC] 0.909; 95% CI: 0.867 to 0.941) was very much comparable to APACHE IV score on day 3(AUC 0.931; 95% CI: 0.893 to 0.960). Serum lactate on day 3 was even better than the SOFA score on day 3(AUC 0.936; 95% CI: 0.898 to 0.963). Among all the parameters, the APACHE IV score on day 3 was the best predictor of mortality at the cut-off point of >132 with a 91.0% chance of correctly predicting mortality. Conclusion: When compared with SOFA and APACHE IV scores, serial serum lactate was reliable and comparable as far as an outcome in terms of mortality is concerned in patients with sepsis admitted to the intensive care unit. Thus, serum lactate can be considered a surrogate marker for predicting mortality in sepsis patients in low-resource rural setups.