ARTERIAL LACTATE LEVELS CAN PREDICT MORTALITY IN SEPSIS

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Sepsis and septic shock may prove fatal hence more than two thirds of septic patients are admitted to the intensive care unit (ICU). Only a few laboratory tests for the markers of sepsis, are currently available. The recent Sepsis-3 guidelines defines sepsis as a dysregulated immune response to infection, and septic shock as persistent hypotension requiring vasopressors with a serum lactate of >2mmol/L despite adequate volume resuscitation. Hence lactate is an important biomarker. This study was aimed to compare the initial lactate level, lactate level after 6 hours of resuscitation and the combined results of both lactate levels of septic patients to predict mortality in critical care settings METHODS: 100 patients with the diagnosis of sepsis or septic shock admitted to ICU were enrolled in this cross-sectional study. One sample of arterial lactate was drawn on presentation. Another sample was drawn after six hours of resuscitation as per ICU protocol that included fluid challenge, vasopressors to keep a MAP > 65mmhg, hydrocortisone, glycemic control and nutrition. Demographic characteristics, acute physiologic assessment and chronic health evaluation (APACHE-II) scores, the sequential organ failure assessment (SOFA) scores, central venous saturations of oxygen (SCVO2), MAP, and lactate clearance levels were noted for all patients. Chi-square analysis was used for evaluation of correlation between mortality and lactate clearance. Quantitative variables were analyzed with independent sample t-tests where the numerical variables had a normal distribution. ANCOVA testing was used for comparison of arterial lactate level between survivors and non-survivors RESULTS: Patients were dividing into 3 groups. Group-1 if their admission concentrations of the arterial lactate were < 3.2mmol/l and had an arterial lactate removal rate of ≥20%; Group-2 if only one of the two criteria were met or Group-3 if they had an admission lactate levels ≥ 3.2mmol with less than 20% lactate removal rate. The sensitivity and specificity of this model for mortality prediction was 88% and 95% respectively with a predictive value of 91% based on ROC curve analysis. CONCLUSIONS: From the 17 patients in Group 2, 10 (59%) died, while from 63 patients in Group 1, only 5 patients (8%) died. 100% of Group 3 patients died. CLINICAL IMPLICATIONS: The study indicates that the combination of arterial lactate level and the rate of lactate removal can be used as useful predictor of mortality in critically sick septic patients DISCLOSURES: no disclosure on file for Ata Mahmoodpoor; no disclosure on file for Nader Nader; No relevant relationships by Rukma Parthvi, source=Web Response no disclosure on file for Sarvin Sanaie