Role of Arterial versus Venous Lactate and Base Deficit in Assessing Prognosis of Septic Patients

Abstract

Abstract Background Septic shock is a syndrome of pathologic, physiologic, and biochemical disturbances caused by infection, and it is a major public health concern worldwide. Many techniques have been developed for the early detection of septic shock and prompt resuscitation. Lactate-guided resuscitation decreased mortality in patients with septic shock compared to that of resuscitation without lactate monitoring. In 2016, the international consensus launched a new sepsis definition (Sepsis-3), which is composed of the sepsis condition, the need for a vasopressor to maintain a mean arterial pressure of ≥ 65 mmHg and a serum lactate level rising to be ≥ 2 mmol/L in the absence of hypovolemia. Aim of the Work The aims of the study are to determine if lactate and standard base deficit can be used interchangeably in patients with septic shock in the emergency setting and to demonstrate whether venous blood gases could act as a surrogate for arterial blood gases in patients with sepsis syndrome. Patients and Methods This prospective observational study was conducted on 35 patients admitted to the ICU with a diagnosis of sepsis or septic shock in the Intensive Care Units at Ain Shams University Hospitals through 6 months. Results Our study found a significant correlation and high levels of agreement between arterial lactate and peripheral venous lactate in patients admitted to ICU with sepsis indicating the possibility of their interchangeable use. Our data also demonstrated strong correlations across lactate and base excess but not between lactate and anion gap in patients with septic syndrome. The results of our study indicate that base deficit is superior to lactate level as a predictor of mortality. Only, the 2nd arterial and venous base deficit at 24-hours revealed highly significant differences between both survivors and non-survivors. Conclusion Our study demonstrated a high level of agreement in the lactate levels as measured on venous samples and arterial samples in patients with septic syndrome; we also demonstrated that lactate and base excess showed a strong correlation with each other, but not with anion gap. Thus, these biomarkers can be used interchangeably to help in the early determination of septic shock, and also venous lactate levels are reliable in the resuscitation of patients with sepsis. A larger multicenter study may be required to confirm the generalizability of our results.