Abstract
Purpose: Early lactate clearance is an important parameter for prognosis assessment and therapy control in sepsis. Patients with a lactate clearance >0% might differ from patients with an inferior clearance in terms of intensive care management and outcomes. This study analyzes a large collective with regards to baseline risk distribution and outcomes. Methods: In total, 3299 patients were included in this analysis, consisting of 1528 (46%) ≤0% and 1771 (54%) >0% patients. The primary endpoint was intensive care unit (ICU) mortality. Multilevel logistic regression analyses were used to compare both groups: A baseline model (model 1) with lactate clearance as a fixed effect and ICU as a random effect was installed. For model 2, patient characteristics (model 2) were included. For model 3, intensive care treatment (mechanical ventilation and vasopressors) was added to the model. Models 1 and 2 were used to evaluate the primary and secondary outcomes, respectively. Model 3 was only used to evaluate the primary outcomes. Adjusted odds ratios (aORs) with respective 95% confidence intervals (CI) were calculated. Results: The cohorts had no relevant differences regarding the gender, BMI, age, heart rate, body temperature, and baseline lactate. Neither the primary infection focuses nor the ethnic background differed between both groups. In both groups, the most common infection sites were of pulmonary origin, the urinary tract, and the gastrointestinal tract. Patients with lactate clearance >0% evidenced lower sepsis-related organ failure assessment (SOFA) scores (7 ± 6 versus 9 ± 6; p < 0.001) and creatinine (1.53 ± 1.49 versus 1.80 ± 1.67; p < 0.001). The ICU mortality differed significantly (14% versus 32%), and remained this way after multivariable adjustment for patient characteristics and intensive care treatment (aOR 0.43 95% CI 0.36–0.53; p < 0.001). In the additional sensitivity analysis, the lack of lactate clearance was associated with a worse prognosis in each subgroup. Conclusion: In this large collective of septic patients, the 6 h lactate clearance is an independent method for outcome prediction.
Highlights
Sepsis is one of the most common and deadly diseases worldwide
1528 (46%) without and 1771 (54%) septic patients with a lactate clearance greater 0% were investigated in this study
Patients with a lactate clearance greater 0% were less sick in terms of sepsis-related organ failure assessment (SOFA), had a lower baseline creatinine, and lower lactate after 6 h
Summary
Sepsis is one of the most common and deadly diseases worldwide It is characterized by a life-threatening “disproportionate” immune response to infection, with high mortality [1,2]. Lactate metabolism had been introduced as one of the most promising approaches for individualized treatment in septic patients [7,8]. That lactate is a central key in glucose metabolism, and is not the result of anaerobic glycolysis [10]. Serum lactate is influenced by many other factors (catecholamine-use in septic shock, alkalosis-induced increased glucose metabolism, lactate buffered continuous hemofiltration, liver dysfunction, and lung lactate production) [14,15]. It is likely hardly possible to recognize the weight of the individual factors
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