Abstract
Whether lactate clearance (LC) influences outcomes differently depending on the infection site in sepsis cases is not fully elucidated. Herein, we analyzed LC’s clinical utility as a predictor of patient outcomes according to infection site. This retrospective study, conducted at two tertiary emergency critical care medical centers in Japan, included patients with sepsis or septic shock. The associations between infection site (lungs vs. other organs) and in-hospital mortality and ventilator-free days (VFDs) were evaluated using univariable and multivariate analyses. We assessed LC’s ability to predict in-hospital mortality using the area under the receiver operating characteristic curve. Among 369 patients with sepsis, infection sites were as follows: lungs, 186 (50.4%); urinary tract, 45 (12.2%); abdomen, 102 (27.6%); and other, 36 (9.8%). Patients were divided into a pneumonia group or non-pneumonia group depending on their infection site. The pneumonia group displayed a higher in-hospital mortality than the non-pneumonia group (24.2% vs. 15.8%, p = 0.051). In the multivariate analysis, lower LC was associated with higher in-hospital mortality [adjusted odds ratio (AOR), 0.97; 95% confidence interval (CI) 0.96–0.98; p < 0.001] and fewer VFD [adjusted difference p value (AD), − 1.23; 95% CI − 2.42 to − 0.09; p = 0.025] in the non-pneumonia group. Conversely, LC did not affect in-hospital mortality (AOR 0.99; 95% CI 0.99–1.00; p = 0.134) and VFD (AD − 0.08; 95% CI − 2.06 to 1.91; p = 0.854) in the pneumonia group. Given the differences in the impact of LC on outcomes between the pneumonia and non-pneumonia groups, this study suggests that optimal treatment strategies might improve outcomes. Further studies are warranted to validate our results and develop optimal therapeutic strategies for sepsis patients.
Highlights
Whether lactate clearance (LC) influences outcomes differently depending on the infection site in sepsis cases is not fully elucidated
While we found a significant association after adjusting for age and Sequential Organ Failure Assessment (SOFA) scores between a lower LC and higher in-hospital mortality and less ventilator-free days (VFDs) in the overall population and non-pneumonia group, we did not observe a significant impact of LC on either outcome in the pneumonia group
There was almost no difference between the area under the curve (AUC) for age and SOFA scores and that for age, SOFA scores, and LC (0.796 vs. 0.803) in the pneumonia group (Fig. 3a), the AUC for age, SOFA scores, and LC was higher than that for age and SOFA scores (0.848 vs. 0.746) in the non-pneumonia group (Fig. 3b). In this retrospective observational study, after adjusting for potential confounders, we observed a lower impact of LC on in-hospital mortality and VFD in the pneumonia group than in the non-pneumonia group
Summary
Whether lactate clearance (LC) influences outcomes differently depending on the infection site in sepsis cases is not fully elucidated. We analyzed LC’s clinical utility as a predictor of patient outcomes according to infection site. This retrospective study, conducted at two tertiary emergency critical care medical centers in Japan, included patients with sepsis or septic shock. Lower LC was associated with higher in-hospital mortality [adjusted odds ratio (AOR), 0.97; 95% confidence interval (CI) 0.96–0.98; p < 0.001] and fewer VFD [adjusted difference p value (AD), − 1.23; 95% CI − 2.42 to − 0.09; p = 0.025] in the non-pneumonia group. There is a need for judicious fluid therapy to achieve a more gradual improvement in LC in patients with pneumonia, suggesting different clinical impacts of LC between those with pneumonia and with other infections. We analyzed the performance of LC in predicting patient outcomes according to their sites of infection
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