The relationship between arterial blood lactate clearance, prognosis and myocardial damage in patients with septic shock after early goal-directed therapy

Abstract

Objective: To evaluate the prognostic value of arterial blood lactate clearance based on central venous oxygen saturation and perfusion index in patients with septic shock related myocardial injury after early goal-directed therapy. Methods: One hundred and fifty-seven patients with septic shock after early resuscitation were enrolled from August 2013 to July 2016 in ICU at Peking Union Medical College Hospital. Parameters indicating early resuscitation included central venous pressure (CVP) 8-12 mmHg (1 mmHg=0.133 kPa),mean arterial pressure (MAP) >65 mmHg, central venous oxygen saturation(ScvO(2))>70% and urine volume (UO) >0.5ml·kg(-1)·h(-1) and arterial blood lactate (Lac) >2 mmoL/L.Patients were divided into group A [ScvO(2)>80% and perfusion index (PI)>1.4], group B(ScvO(2)>80% and PI<1.4),group C(ScvO(2)<80% and PI>1.4),group D(ScvO(2)<80% and PI<1.4).Hemodynamic parameters and tissue perfusion indexes at 2 hours(T2),4 hours(T4) and 6 hours(T6) after early resuscitation and troponin I which indicated myocardial damage, on day 1 2 3 in ICU were recorded. Results: ⑴Lac clearance in group C was the quickest, which was 34.57% (21.44%, 44.20%) , 58.33% (30.19%, 70.79%) , 71.43% (53.75%, 82.79%) at T2, T4, T6 respectively.⑵The maximal incidence of myocardial damage was in group B(85.0%) and the lowest in group A (45.7%) on day 1 in ICU.Whereas on day 2, group C showed the lowest incidence of myocardial damage (29.3%) and group B the highest(70.0%). On day 3,the proportion of elevated troponin I in group B was 70.0%, which was significantly higher than that of group B (29.3%,P<0.008).⑶Logistic regression analysis suggested that the rate of Lac clearance at T4 in group B was related to the incidence of myocardial damage on day 2 and 3 in ICU. Conclusions: The combination of PI and ScvO(2) as a resuscitation target in patients with septic shock facilitates Lac clearance as the goal of resuscitation.The rate of arterial Lac clearance based on ScvO(2) and PI is correlated with myocardial injury in patients with septic shock after early goal-directed therapy.