Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country

Abstract

Background Single lactate measurements have been reported to have prognostic significance, however, there is a lack of data in local literature from Pakistan. This study was done to determine prognostic role of lactate clearance in sepsis patients being managed in our lower-middle income country. Methods This prospective cohort study was conducted from September 2019-February 2020 at the Aga Khan University Hospital, Karachi. Patients were enrolled using consecutive sampling and categorized based on their lactate clearance status. Lactate clearance was defined as decrease by 10% or greater in repeat lactate from the initial measurement (or both initial and repeat levels <=2.0 mmol/L). Results A total 198 patients were included in the study, 51% (101) were male. Multi-organ dysfunction was reported in 18.6% (37), 47.7% (94) had single organ dysfunction, and 33.8% (67) had no organ dysfunction. Around 83% (165) were discharged and 17% (33) died. There were missing data for 25.8% (51) of the patients for the lactate clearance, whereas 55% (108) patients had early lactate clearance and 19.7% (39) had delayed lactate clearance.On univariate analysis, mortality rate was higher in patients with delayed lactate clearance (38.4% vs 16.6%) and patients were 3.12 times (OR = 3.12; [95% CI: 1.37-7.09]) more likely to die as compared with early lactate clearance. Patients with delayed lactate clearance had higher organ dysfunction (79.4% vs 60.1%) and were 2.56 (OR = 2.56; [95% CI: 1.07-6.13]) times likely to have organ dysfunction. On multivariate analysis, after adjusting for age and co-morbids, patients with delayed lactate clearance were 8 times more likely to die than patients with early lactate clearance [aOR = 7.67; 95% CI:1.11-53.26], however, there was no statistically significant association between delayed lactate clearance [aOR = 2.18; 95% CI: 0.87-5.49)] and organ dysfunction. Conclusion Lactate clearance is a better determinant of sepsis and septic shock effective management. Early lactate clearance is related to better outcomes in septic patients.

The relationship of CURB65-L and CURB65-LC (lactate clearance) with mortality in pneumonia patients admitted to the emergency department

“…Since the sensitivity and specificity of a single lactate value is controversial, it has been stated that serial measurements over time or LC may be more reliable indicators [5,7]. A study found that focusing on LC rather than a single lactate level would have a more significant impact on reducing mortality [19]. Yadigaroğlu M. et al highlighted that LC levels in the 24th hour, as opposed to lactate at admission, can serve as a reliable predictor of mortality in patients with COVID-19 [6].…”

Influence of Lactate on Prognostic Value of Patients with Septic Shock

“…When the serum lactate concentration is greater than 10 mmol/L, the patient mortality rate can reach 80%, as recorded by Bai Huiying in the compilation of critical illness emergency medicine in China [3]. The medical journal compiled by Yang Mingxing shows that if severe lactic acidosis persists for 48 hours, the mortality rate can reach 100% [4]. Li et al found that blood lactate concentration is an important parameter for evaluating the prognosis of critically ill patients [5].…”

Lactate dynamics in paediatric patients with severe sepsis: insights from a prospective cohort study

“…Additionally, lactate clearance is an approximate percentage of the reduction in lactate levels following early resuscitation and is a plausible method for predicting mortality [6]. Increased lactate levels correlate with poor outcomes, and survival can be predicted in critically ill adults with septic shock through early lactate clearance [7][8][9][10]. However, the predictive accuracy of lactate clearance in children with severe sepsis has not been fully investigated [4,11].…”