Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock

Thomas-Rueddel, D.; Poidinger, Bernhard; Weiß, Manfred; Bach, Friedhelm; Dey, Karin; Häberle, Helene; Kaisers, Udo X.; Rüddel, Hendrik; Schädler, Dirk; Scheer, Christian; Schreiber, Torsten; Schürholz, Tobias; Simon, Philipp; Sommerer, A.; Schwarzkopf, Daniel; Weyland, A.; Wöbker, Gabriele; Reinhart, Konrad; Bloos, Frank

doi:10.1016/j.jcrc.2014.10.027

Cited by 72 publications

(56 citation statements)

References 35 publications

(96 reference statements)

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“…Univariate testing did not detect significant differences in the rates or rapidity of critical therapeutic interventions among patients experiencing early death; whereas failure to normalize serum lactate (persistent lactate elevation), initial pH, and early blood culture positivity were significant predictors of early death in the univariate analysis. While some of these factors are known to predict in-hospital mortality or increased ICU lengths of stay in sepsis[6,14,15] to our knowledge this is the first study to associate these clinical features with mortality within the first 24 hours of presentation of sepsis. These findings may have implications for risk stratification of patients with severe sepsis or septic shock in addition to early identification of those in whom aggressive management may be needed to decrease risk of death or inform alternative goals of care.…”

Section: Discussionmentioning

confidence: 99%

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Clinical predictors of early death from sepsis

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Guirgis

Sterling

et al. 2017

Journal of Critical Care

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Purpose Patients with severe sepsis who experience rapid, early deterioration and death are of particular concern. Our objective was to identify predictors of early death in Emergency Department (ED) patients with severe sepsis. Methods Secondary analysis of two prospective studies of adult ED patients with severe sepsis. The primary outcome was early death, defined as death within 24 hours of triage. Results Out of 410 severe sepsis admissions, 20 patients experienced early death. These patients demonstrated significantly higher initial lactate (7.3 versus 3.3 mmol/L, p < 0.001) and modified SOFA (mSOFA) scores (10 vs 6, p<.001), were less likely to normalize their lactate (p<0.001), had lower initial pH (p<0.001), and more frequently had early positive blood cultures (p=0.021). Multivariable logistic regression identified initial serum lactate level (OR 1.19, 95% CI 1.06–1.35) and mSOFA score (OR 1.17, 95% CI 1.00–1.36) as independent predictors of early death. A repeat lactate ≥ 5 mmol/L had a sensitivity of 55% and specificity of 89% for early death. There were no significant treatment differences between groups. Conclusion Initial serum lactate and mSOFA score were independent predictors of mortality within 24 hours of ED admission in patients with severe sepsis.

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Section: Discussionmentioning

confidence: 99%

“…[3,4,5] Several studies have demonstrated the role for these clinical indicators in independently predicting in-hospital mortality in patients with sepsis. [6,7]…”

Section: Introductionmentioning

confidence: 99%

Clinical predictors of early death from sepsis

Javed

Guirgis

Sterling

et al. 2017

Journal of Critical Care

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“…Another source of bias was the population enrollment criteria, in which organ dysfunction and hypoperfusion were regarded as an initial SBP of <90 mm Hg, despite a 20 mL/kg intravenous crystalloid fluid challenge; or an initial serum lactate level ≥4 mmol/L. These criteria did not completely encompass severe sepsis; however, lactate is a commonly used marker of hypoxic tissue 36. Accordingly, these patients could be regarded as severely septic in our study.…”

Section: Discussionmentioning

confidence: 99%

Hypoalbuminemia, Low Base Excess Values, and Tachypnea Predict 28-Day Mortality in Severe Sepsis and Septic Shock Patients in the Emergency Department

et al. 2016

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PurposeThe objective of this study was to develop a new nomogram that can predict 28-day mortality in severe sepsis and/or septic shock patients using a combination of several biomarkers that are inexpensive and readily available in most emergency departments, with and without scoring systems.Materials and MethodsWe enrolled 561 patients who were admitted to an emergency department (ED) and received early goal-directed therapy for severe sepsis or septic shock. We collected demographic data, initial vital signs, and laboratory data sampled at the time of ED admission. Patients were randomly assigned to a training set or validation set. For the training set, we generated models using independent variables associated with 28-day mortality by multivariate analysis, and developed a new nomogram for the prediction of 28-day mortality. Thereafter, the diagnostic accuracy of the nomogram was tested using the validation set.ResultsThe prediction model that included albumin, base excess, and respiratory rate demonstrated the largest area under the receiver operating characteristic curve (AUC) value of 0.8173 [95% confidence interval (CI), 0.7605–0.8741]. The logistic analysis revealed that a conventional scoring system was not associated with 28-day mortality. In the validation set, the discrimination of a newly developed nomogram was also good, with an AUC value of 0.7537 (95% CI, 0.6563–0.8512).ConclusionOur new nomogram is valuable in predicting the 28-day mortality of patients with severe sepsis and/or septic shock in the emergency department. Moreover, our readily available nomogram is superior to conventional scoring systems in predicting mortality.

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“…Lactate levels are further increased in this situation by decreased elimination and enzyme induction. In the context of sepsis, lactate can be used for prognosis as well as for treatment monitoring (stagnation or diminishment of plasma concentrations; [51][52][53][54][55]). After years of controversial discussion, the new definition of septic shock [5] states the criterium of hyperlactatemia >2 mmol/l (≈18 mg/dl) as obligatory for diagnosis [10].…”

Section: Lactatementioning

confidence: 99%