Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock.
J Crit Care
; 37: 179-184, 2017 02.
Article
en En
| MEDLINE
| ID: mdl-27771598
ABSTRACT
PURPOSE:
Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4mmol/L, we compared mortality prediction between a subsequent lactate ≥4mmol/L to a <10% and <20% decrease between initial and subsequent lactate values. MATERIALS ANDMETHODS:
We performed a single-center retrospective study of patients presenting to the emergency department with an initial lactate ≥4mmol/L and suspected infection. Patients were stratified by lactate reduction using 3 previously identified definitions (subsequent lactate ≥4mmol/L, and <10% and <20% relative decrease in lactate) and compared using multivariable logistic regression. Sensitivity and specificity were compared using McNemar test.RESULTS:
A subsequent lactate ≥4mmol/L and a lactate reduction <20% were associated with increased in-hospital mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.24-8.16; P=.02 and OR, 3.11; 95% CI, 1.39-6.96; P=.006, respectively), whereas a lactate reduction <10% was not (OR, 1.13; 95% CI, 0.94-1.34; P=.11). A subsequent lactate ≥4mmol/L and a lactate reduction <20% were more sensitive than a lactate reduction <10% (72% vs 41%, P=.002 and 62% vs 41%, P=.008, respectively) but less specific (57% vs 76%, P<.001 and 67% vs 76%, P=.002, respectively).CONCLUSIONS:
A subsequent lactate ≥4mmol/L and lactate reduction <20% were associated with increased in-hospital mortality, whereas a lactate reduction <10% was not. Sensitivity and specificity are different between these parameters.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
4_TD
Problema de salud:
4_sepsis
Asunto principal:
Biomarcadores
/
Sepsis
/
Ácido Láctico
Tipo de estudio:
Diagnostic_studies
/
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Aged80
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Crit Care
Asunto de la revista:
TERAPIA INTENSIVA
Año:
2017
Tipo del documento:
Article