Initial Lactate Level and Mortality in Septic Shock Patients With Hepatic Dysfunction

Kang, Yeh Rim; Jeon, Eun Ju; Uhm, Sang Won; Suh, Ji Yeong; Jung, Man Pyo; Kim, Ho Jung; Kwon, O Jung; Jeon, Kyong Man

doi:10.1378/chest.10467

Cited by 9 publications

(10 citation statements)

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“…Serum lactic acid measurement has a predicting rule for mortality in sepsis and recommended in first hour for early recognition of sepsis. In our study mortality rate was high (75%) for those patients whom serum lactate level more than 2 mmol/liter, this result is comparable to other studies done in Sao Paulo brazil in 2016 [27], Vancouver Canada in 2012 [28] and Seoul south Korea in 2011 [29]. In our study 26% have negative blood culture which was lower compared to other studies done in Singapore (41.5%) in 2013 [30] and in Spain (35%) in 2008 [31].…”

Section: Discussionsupporting

confidence: 81%

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Ahmad¹,

Ismaeel

Mohammed

et al. 2018

KJAR

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Sepsis is a very common condition in emergency hospitals and presentation is variable, it is under diagnosed with very high mortality rate. All patients with infection are at risk of developing sepsis. Sepsis is a complex condition characterized by activation of inflammatory process and coagulation system in response to microbial insult. An observational prospective study was carried out at RozhHalat emergency hospital in Erbil-Kurdistan region of Iraq between February 2017 to January 2018.The study was approved by the scientific and ethical committee of Kurdistan board of medical specialties. 50 patients aged between (10 -80) years old presented to this hospital with sign and symptoms of infection were recruited to this study. 50 patients with signs and symptoms of sepsis were recorded in this study. The mean age was 47 with male to female ration of 2:3 (42% male and 58% female). The overall mortality rate was high at 68% with higher rate among female and older age group. The blood culture was positive in 74% of cases of which 52% were gram positive and 22% were gram-negative microorganisms. A Positive blood culture associated with higher mortality rate of 81% compared with 21% if the blood culture was negative. In majority of cases the site of infection was from multiple source (34%) followed by respiratory infection (26%).Skin and soft tissue infection was associated with the lowest mortality of 2.9%. High number of cases (82%) developed complications and 52% of cases developed more than 2 organ failures. All patients received empirical antibiotic therapy however 46% of cases received the wrong antimicrobials. The survival rate was higher (44%) among patients given the right antibiotics. Similarly patients had better chance of survival if appropriate fluid resuscitation therapy was give. The overall mortality among vasopressor treated patients were 72% compared with 78% chance of mortality if they were not treated with any vasopressor therapy, among those who received inotropic supportNoradrenaline associated with higher survival rate(72%). A qSOFA score of more than 2 associated with 86.4 % of mortality compared with 75.5% mortality with similar SIRS criteria. Factors associated with high mortality were: female gender, older age group, positive blood culture, wrong antibiotics therapy, less fluid resuscitation, multisource of infection, multi-organ failure, high lactic acid level and high qSOFA score. This study shows that sepsis is associated with high overall mortality rate of 68% in the RozhHalat emergency hospital and higher rate of death among female and older age group. Negative blood culture, appropriate use of antibiotics and fluid therapy associated with better chance of survival. Vasopressor therapy did not result in better survival outcome except for Noradrenaline. The qSOFA score is as good as SIRS criteria in predicting mortality. High lactate, multi-organ failure and multisource of infection associated with the worst outcome.

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Section: Discussionsupporting

confidence: 81%

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Ahmad¹,

Ismaeel

Mohammed

et al. 2018

KJAR

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“…The role of microcirculatory derangements has been highlighted in recent years and these abnormalities may hasten the development of tissue hypoxia and/or multiple organ dysfunction [30 & ]. To add more complexity, other factors such as hyperadrenergia [40], hypermetabolism [41], hyperinflammation [42], organ dysfunctions [43] or the effect of concurrent therapies may further complicate the interpretation of each perfusion marker. To add more complexity, other factors such as hyperadrenergia [40], hypermetabolism [41], hyperinflammation [42], organ dysfunctions [43] or the effect of concurrent therapies may further complicate the interpretation of each perfusion marker.…”

Section: Key Pointsmentioning

confidence: 99%

“…Sustained hyperadrenergia [40,46 & ,47], hypermetabolism [41], hyperinflammation [42], liver dysfunction [43], among others, may contribute to hyperlactatemia. Sustained hyperadrenergia [40,46 & ,47], hypermetabolism [41], hyperinflammation [42], liver dysfunction [43], among others, may contribute to hyperlactatemia.…”

Section: Interpretation Of Perfusion Markers: Toward a Multimodal Appmentioning

confidence: 99%

The holistic view on perfusion monitoring in septic shock

Hernández

Bruhn

Castro

et al. 2012

Current Opinion in Critical Care

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All individual perfusion parameters have extensive limitations to adequately reflect tissue perfusion during persistent sepsis-related circulatory dysfunction. A multimodal approach integrating macrohemodynamic, metabolic, peripheral and eventually microcirculatory perfusion parameters may overcome those limitations. This approach may also provide a thorough understanding on the predominant driving forces of hypoperfusion, and lead to physiologically oriented interventions.

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“…Thus, it is expected that foals with clinical evidence of hypoperfusion will have increased concentrations of aldosterone and AVP which will be associated with markers of volume depletion and impaired tissue perfusion such as L‐lactate. A number of studies in critically ill human patients, adult horses and foals have shown that blood L‐lactate concentrations reflect tissue hypoperfusion and can be used as a prognostic indicator of morbidity and mortality ; however, a direct association among aldosterone, AVP, hyperlactataemia and clinical, and laboratory signs of hypoperfusion in equine neonates remains to be made.…”

Section: Introductionmentioning

confidence: 99%

Association of aldosterone and arginine vasopressin concentrations and clinical markers of hypoperfusion in neonatal foals

Dembek

Hurcombe

Stewart

et al. 2015

Equine Veterinary Journal

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Initial Lactate Level and Mortality in Septic Shock Patients With Hepatic Dysfunction

Cited by 9 publications

References 0 publications

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

The holistic view on perfusion monitoring in septic shock

Association of aldosterone and arginine vasopressin concentrations and clinical markers of hypoperfusion in neonatal foals

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