Disturbed fluid responsiveness and lactate/pyruvate ratio as predictors for mortality of septic shock patients

Abstract

Objectives: Evaluation of fluid responsiveness of septic shock patients admitted to surgical ICU and the predictability of non-invasive monitoring and estimated lactate/pyruvate (L/P) ratio for survival of these patients. Patients and methods: The study included 58 septic shocked patients admitted and managed at surgical ICU. After non-invasive determination of baseline hemodynamic data and calculation of shock index (SI-0) and Pleth variability index (PVI-0), all patients received intravenous colloid infusion followed 15-min later by non-invasive re-evaluation for SI-15 and PVI-15. Blood samples were obtained for estimation of blood lactate and pyruvate levels at admission (BLL-0 and BPL-0) and 12-h after fluid resuscitation (BLL-12 and BPL-12) and L/P ratio was calculated. All patients were managed according to the Surviving Sepsis Campaign guidelines and followed up for ICU mortality rate (MR). Results: ICU stay MR was 20.7%. Survival showed negative significant correlation with PVI, L/P ratio and BLL, while it showed positive significant correlation with BPL. Receiver Operating Characteristic (ROC) curve analysis defined baseline and persistently low PVI, high BLL and L/P ratio as significant sensitive predictors for MR, while elevated BPL-12 as significant specific predictor for survival. Regression analysis defined persistently elevated L/P ratio as the highly significant specific predictor, while persistently disturbed SI and PVI could predict mortality as screening tests. Odds ratio for mortality at BLL-0 of >2 mmol/L was 0.0321 (95% CI: 0.0037-0.2755), while it was 4.1111 (95% CI: 1.0702-15.792) at BLL-0 >4 mmol/L. Conclusion: After fluid resuscitation and hemodynamic stability, persistently elevated BLL could predict mortality, while elevated BPL could predict survival of septic shock patients. Continuous non-invasive evaluation of fluid responsiveness judged by PVI and SI could provide sensitive

Índice lactato/albúmina como predictor de mortalidad en sepsis y choque séptico

“…Uno de los objetivos en recientes estudios ha sido la simplifi cación de estas escalas tratando de que puedan emplearse de forma práctica, sencilla y al pie de cama, lo cual ha arrojado resultados satisfactorios y prometedores. 1 La búsqueda de nuevos factores pronósticos en la sepsis ha incluido múltiples parámetros, 2 el lactato ha reportado grandes resultados [3][4][5] y la albúmina por su parte también se ha empleado recientemente como predictor de mortalidad. 6 El índice entre el lactato y la albúmina es una forma novedosa y atractiva en la determinación de mortalidad en el proceso séptico.…”