Abstract
Background: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, the clinical picture alone is not sufficient for assessing disease severity and outcomes. Because blood lactate level is included in the clinical criteria of SS it should be considered to improve the assessment of its severity. This study aims to investigate the relationship between pre-hospital blood lactate level and 30-day mortality in patients with SS. Methods: From 15 April 2017 to 15 April 2019, patients with SS requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were prospectively included in the LAPHSUS study, an observational, non-randomized controlled study. Pre-hospital blood lactate levels were measured at the time of first contact between the patients and the MICU. Results: Among the 183 patients with septic shock requiring action by the MICU drawn at random from LAPHSUS study patients, six (3%) were lost to follow-up on the 30th day and thus 177 (97%) were analyzed for blood lactate levels (mean age 70 ± 14 years). Pulmonary, urinary and digestive infections were probably the cause of the SS in respectively 58%, 21% and 11% of the cases. The 30-day overall mortality was 32%. Mean pre-hospital lactatemia was significantly different between patients who died and those who survived (respectively 7.1 ± 4.0 mmol/L vs. 5.9 ± 3.5 mmol/L, p < 10−3). Using Cox regression analysis adjusted for potential confounders we showed that a pre-hospital blood lactate level ≥ 4 mmol/L significantly predicted 30-day mortality in patients with SS (adjusted hazard ratio = 2.37, 95%CI (1.01–5.57), p = 0.04). Conclusion: In this study, we showed that pre-hospital lactatemia predicts 30-day mortality in patients with septic shock handled by the MICU. Further studies will be needed to evaluate if pre-hospital lactatemia alone or combined with clinical scores could affect the triage decision-making process for those patients.
Highlights
Every year, sepsis affects more than 30 million people worldwide [1,2,3], leading to 11 million deaths
From 15 April 2017 to 15 April 2019, patients with a diagnosis of septic shock according to the SFAR-SRLF criteria [10] were prospectively included in this study by the Mobile Intensive Care Unit intervention (MICU) physicians of 9 hospital
Using Cox regression analysis, we observed a statistically significant association between prehospital lactatemia ≥ 4 mmol/L and 30-day mortality with a hazard ratio (HR) of 2.27 (95%CI (1.02–5.05), After adjustment on confounders, the association with 30-day mortality remains significant: ORa (95%CI) = 2.95 (1.14–9.18), p ≤ 10−3) for pre-hospital lactatemia ≥ 4 mmol/L
Summary
Sepsis affects more than 30 million people worldwide [1,2,3], leading to 11 million deaths. Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. This study aims to investigate the relationship between pre-hospital blood lactate level and 30-day mortality in patients with SS. Results: Among the 183 patients with septic shock requiring action by the MICU drawn at random from LAPHSUS study patients, six (3%) were lost to follow-up on the 30th day and 177 (97%) were analyzed for blood lactate levels (mean age 70 ± 14 years). Using Cox regression analysis adjusted for potential confounders we showed that a pre-hospital blood lactate level ≥ 4 mmol/L significantly predicted 30-day mortality in patients with SS (adjusted hazard ratio = 2.37, 95%CI (1.01–5.57), p = 0.04). Conclusion: In this study, we showed that pre-hospital lactatemia predicts 30-day mortality in patients with septic shock handled by the MICU. Further studies will be needed to evaluate if pre-hospital lactatemia alone or combined with clinical scores could affect the triage decision-making process for those patients
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