Abstract
Background
Serum lactate clearance (LC) during initial resuscitation is a potentially useful
prognostic marker in patients with severe sepsis or septic shock. However, it is unclear
whether LC is also associated with the outcome in septic patients with hepatic dysfunction
that may impair lactate elimination, which may contribute to elevated serum lactate
levels or decreased LC.
Methods
The relationships between LC measured within 6 and 24 h after initial resuscitation and hospital mortality were evaluated with multiple
logistic regression analysis.
Results
Of 770 patients with severe sepsis or septic shock, 208 (27%) with hepatic dysfunction
were included in the analysis. The median LC within 6 h in survivors (31.4%) was significantly higher than that of non-survivors (9.3%)
(P = .010). In addition, the median LC within 24 h was also significantly different between groups (51% vs. 12%, P < .001). Low LCs, defined as less than 10% of clearance, at 6 and 24 h were associated with in-hospital mortality. After adjusting for potential confounding
factors, low LCs at 6 and 24 h remained associated with hospital mortality (adjusted OR 4.940, 95% CI 1.762-13.854
at 6 h; adjusted OR 5.997, 95% CI 2.149-16.737 at 24 h). However, LC at 24 h (area under the curve of 0.704) had higher discriminatory power to predict hospital
mortality than LC at 6 h (area under the curve of 0.608) (P = .033).
Conclusions
LC may be useful for predicting outcomes in septic patients with hepatic dysfunction.
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Article Info
Publication History
Published online: February 25, 2016
Accepted:
February 18,
2016
Received in revised form:
February 17,
2016
Received:
December 2,
2015
Footnotes
☆Funding: This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI14C0743).
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
