Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients

Abstract

Purpose: Early lactate clearance is an important parameter for prognosis assessment and therapy control in sepsis. Patients with a lactate clearance >0% might differ from patients with an inferior clearance in terms of intensive care management and outcomes. This study analyzes a large collective with regards to baseline risk distribution and outcomes. Methods: In total, 3299 patients were included in this analysis, consisting of 1528 (46%) ≤0% and 1771 (54%) >0% patients. The primary endpoint was intensive care unit (ICU) mortality. Multilevel logistic regression analyses were used to compare both groups: A baseline model (model 1) with lactate clearance as a fixed effect and ICU as a random effect was installed. For model 2, patient characteristics (model 2) were included. For model 3, intensive care treatment (mechanical ventilation and vasopressors) was added to the model. Models 1 and 2 were used to evaluate the primary and secondary outcomes, respectively. Model 3 was only used to evaluate the primary outcomes. Adjusted odds ratios (aORs) with respective 95% confidence intervals (CI) were calculated. Results: The cohorts had no relevant differences regarding the gender, BMI, age, heart rate, body temperature, and baseline lactate. Neither the primary infection focuses nor the ethnic background differed between both groups. In both groups, the most common infection sites were of pulmonary origin, the urinary tract, and the gastrointestinal tract. Patients with lactate clearance >0% evidenced lower sepsis-related organ failure assessment (SOFA) scores (7 ± 6 versus 9 ± 6; p < 0.001) and creatinine (1.53 ± 1.49 versus 1.80 ± 1.67; p < 0.001). The ICU mortality differed significantly (14% versus 32%), and remained this way after multivariable adjustment for patient characteristics and intensive care treatment (aOR 0.43 95% CI 0.36–0.53; p < 0.001). In the additional sensitivity analysis, the lack of lactate clearance was associated with a worse prognosis in each subgroup. Conclusion: In this large collective of septic patients, the 6 h lactate clearance is an independent method for outcome prediction.

Early evaluation of organ failure using MELD-XI in critically ill elderly COVID-19 patients

“…Another common method to evaluate organ function (and microcirculation) is the assessment of serum lactate [17,18]. In the present study, the lactate-concentration on day 1 and day 2 was higher in the group with MELD-XI ≥ 12.…”

“…Univariate and multivariable logistic regression analyses were performed to assess associations between the MELD-XI score and mortality. We chose the co-variables for the multivariable model (gender [15], age [16], Clinical Frailty Scale [2], intubation and mechanical ventilation [16], renal replacement therapy, and vasoactive drugs) based on clinical experience and previous literature [17,18]. Marginal predictive means with respective 95% confidence intervals (CI) were calculated.…”

Association of chronic heart failure with mortality in old intensive care patients suffering from Covid‐19

“…Co-variables for multivariate models (age, SOFA score, CFS, and sex) were chosen based on clinical experience and previous literature. 14,15 Marginal predictive means with respective 95% confidence intervals were calculated. Kaplan-Meier differences were tested by log-rank test.…”

What Is the Utility of Measuring Lactate Levels in Patients with Sepsis and Septic Shock?

“…74 Since then, a large number of observational studies have found an association between changes in lactate concentration and mortality. 5,46,[75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] A meta-analysis including 15 observational studies, with 5 studies addressing patients with septic shock, found the pooled relative risk of death was 0.41 (95% CI: 0.28-0.60) among patients who met individual study criteria for lactate clearance. 90 These studies contain heterogenous definitions of lactate clearance, including variability in the percent change in lactate that qualified and the time allowed for this change.…”