Abstract
No study has directly measured tissue lactate clearance in patients with sepsis during the post-resuscitation period. In this study we aimed to assess in ICU patients with sepsis (n = 32) or septic shock (n = 79)—during the post-resuscitation phase—the relative kinetics of blood/tissue lactate clearances and to examine whether these are associated with outcome. We measured serially—over a 48-h period—blood and adipose tissue interstitial fluid lactate levels (with microdialysis) and we calculated lactate clearance. Statistics included mixed model analysis, Friedman’s analysis of variance, Wilcoxon’s test, Mann-Whitney’s test, receiver operating characteristics curves and logistic regression. Forty patients died (28-day mortality rate = 28%). Tissue lactate clearance was higher compared to blood lactate clearance at 0–8, 0–12, 0–16, 0–20 and 0–24 h (all p < 0.05). Tissue lactate clearance was higher in survivors compared to non-survivors at 0–12, 0–20 and 0–24 h (all p = 0.02). APACHE II along with tissue lactate clearance <30% at 0–12, 0–20 and 0–24 h were independent outcome predictors. We did not find blood lactate clearance to be related to survival. Thus, in critically ill septic patients, elevated tissue (but not blood) lactate clearance, was associated with a favorable clinical outcome.
Highlights
Sepsis refers to the infectious syndrome complicated by acute organ dysfunction, whereas septic shock represents the most severe clinical situation of sepsis, characterized by hypotension not reversed with fluid resuscitation
We found that a lactate adipose tissue clearance below 30%, identified non-survivors from survivors, with sensitivities of 93%, 83% and 80%, and specificities of 27%, 40% and 43%, at H0–H12, H0–H20, and
We found that a lactate adipose tissue clearance below 30%, identified non-survivors from survivors, with sensitivities of 93%, 83% and 80%, and specificities of 27%, 40% and 43%, at H0–H12, H0–H20, and H0–H24, respectively
Summary
Sepsis refers to the infectious syndrome complicated by acute organ dysfunction, whereas septic shock represents the most severe clinical situation of sepsis, characterized by hypotension not reversed with fluid resuscitation. While it is widely accepted that blood lactate and its clearance are linked to survival, it remains currently disputed whether these should be used as an end-point of early goal-directed therapy in critical ill septic patients [3]. This is largely based on the knowledge that in critically patients other processes unrelated to tissue hypoxia may increase lactate levels; these include increased glycolysis, mitochondrial dysfunction, defects in pyruvate metabolism or prolonged lactate clearance due to liver dysfunction [11]
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