PS1278 LACTATE CLEARANCE AS A SURVIVAL PREDICTOR IN PATIENTS WITH HEMATOLOGIC DISEASES WITH SEPTIC SHOCK

Abstract

Background:Infectious complications are one of the main causes of mortality in patients with hematological diseases. Neutropenia is common adverse effect of antitumor treatment. These patients have high risks of development severe infectious complications (sepsis and septic shock). It is known, that poor lactate clearance is associated with increased mortality in the general population of patient's. We evaluated the prognostic value of lactate clearance in patients with neutropenia grade 4 (CTCAE v4.0)Aims:To evaluate the clinical outcomes of septic shock treatment in patients with myelotoxic agranulocytosis depending on the clearance of lactate.Methods:127 patients with septic shock were included (between July 2015 and December 2018). A prospective and retrospective diagnosis of septic shock was established on the basis of Sepsis 3 criteria: arterial hypotension in combination with an increase in lactate of more than 2.0 mmol / l. The highest incidence of septic shock (up to 35%) was registered in high‐risk group patients: during the induction remission of acute myeloid leukemia and recipients of allogeneic hematopoietic stem cells. 88 percent cases were associated with gram‐negative bacteria (Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, Serratia spp. and E. coli). The median duration of neutropenia before the development of septic shock was 15.1 (13.26–17.06) and 17.72 (16.33–19.12) days in patients who died and survived (p = 0.03, Log Rank). The levels of C‐reactive protein and procalcitonin did not differ.Results:The median lactate values at the time of diagnosis of septic shock in survivors and non‐survivors patients were 2.9 (3.071 ‐ 3.997) and 4.26 (3.665–4.867) mmol / l (p = 0.05, Log rank). 30 ‐ day overall survival (OS) in patients with a lactate level of more than 4.0 mmol/l was 34%, with a lactate level of 2.0–4.0 mmol/l was 56% (p <0.001, Log Rank). All patients received serial lactate measurements were divided into lactate clearance >10% (n = 26), >20% (n = 46), and <10% (n = 55) groups. Patients with a lactate clearance of more than 10% had higher 30‐day OS (68% vs. 29%, p < 0.01, Log Rank). The rate of lactate elimination (more than 10% versus more than 20%) did not have an additional effect on OS. In multivariate analysis with an additional assessment of the venous‐to‐arterial carbon dioxide tension, absolute lactate values, the prognostic value was shown only for the lactate clearance.Summary/Conclusion:Achieving lactate clearance during the first 6 hours treatment septic shock more than 10% is associated with improved 30‐day OS in patients with severe neutropenia. The advantage of this marker is an early assessment of the effectiveness of therapy. In the future, on the basis of lactate kinetics, it is possible to create the strategy of ”Early Goal‐Directed Therapy“.image