Lactate Measurements in Sepsis-Induced Tissue Hypoperfusion

Abstract

Serum lactate was commonly measured within 6 hours of presentation in the management of severe sepsis or septic shock in this subset analysis of the Surviving Sepsis Campaign database in accordance with the Surviving Sepsis Campaign guidelines. Our results demonstrate that elevated lactate levels are highly associated with in-hospital mortality. However, only patients who presented with lactate values greater than 4 mmol/L, with and without hypotension, are significantly associated with in-hospital mortality and is associated with a significantly higher risk than intermediate levels (2-3 and 3-4 mmol/L). This supports the use of the cutoff of greater than 4 mmol/L as a qualifier for future clinical trials in severe sepsis or septic shock in patient populations who use quantitative resuscitation and the Surviving Sepsis Campaign bundles as standard of care.

Developing a New Definition and Assessing New Clinical Criteria for Septic Shock

“…The SSC database setup, inclusion, and reporting items are described in detail elsewhere. 6,17 To select clinical criteria for the new septic shock definition, an analysis data set was created that included all patients with a serum lactate level measurement or a mean arterial pressure less than 65 mmHg after fluids, or who received vasopressors.…”

Objective Sepsis Surveillance Using Electronic Clinical Data

“…13–16 We performed a sensitivity analysis, however, to assess whether and how the inclusion of lactate (with a level ≥2.0mmol/L) would affect the perceived incidence of severe sepsis over time. We also explored the utility of a parsimonious “simplified surveillance definition” that required only evidence of suspected infection and vasopressors, initiation of mechanical ventilation for at least 2 days, or an acute rise in creatinine—reflecting the most common forms of organ dysfunction associated with sepsis.…”

Bacterial sepsis

“…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]. In an analysis of data from more than 280,000 patients of the SSC collective, Casserly et al [53] showed that hyperlactatemia >4 mmol/l and low lactate clearance during the first 6 h were associated with a significant increase in in-hospital mortality.…”

“…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].…”