Lactic acid as an adjuvant marker in pregnancy-associated sepsis

Abstract

RESEARCHBackground. Lactic acid level is one index which is currently actively researched for its role in pregnancy-associated sepsis (PAS). We aimed to quantify the severity of PAS using lactic acid levels. Methods. All pregnant, post-abortal (2 weeks) and postpartum women (up to 6 weeks) with clinical sepsis were enrolled as per systemic inflammatory response syndrome criteria, and lactic acid levels were estimated at admission. Severe PAS was defined as one or more organ dysfunctions due to sepsis. The severity of obstetric sepsis was graded according to number of organ failures. Results. There were 42 patients with non-severe PAS, and 58 with severe PAS. The ≥4 mmol/L lactic acid threshold had 88.10% specificity and 37.93% sensitivity for detection of severe PAS. A significant difference (p=0.006) was found between lactic acid levels (mean (standard deviation (SD)) in cases with single OF (n=24; 3.02 (0.92) mmol/L) v. multi-organ failure (n=34; 3.70 (0.81) mmol/L). The mean (SD) lactic acid levels (3.76 (0.97) mmol/L) with any type of culture-positive PAS cases (n=35) were significantly higher than in culture-negative PAS cases (2.95 (0.98); p=0.0001). Conclusions. Lactic acid level ≥4 mmol/L had reasonable specificity for severity and culture positivity in PAS. A serum lactic acid level ≥3 mmol/L was associated with more number of organ failures. Lactic acid as an adjuvant marker in pregnancy-associated sepsis Lactic acid is one of the products of anaerobic metabolism related to hypovolemia and hypoxia. Following the recognition of lactic acid importance in critical care management of sepsis in general, its use was extended to pregnancy-associated sepsis (PAS).[1] The existing evidence on the subject is still scanty. [2][3][4][5] The only focused study of lactic acid measurements in obstetric sepsis indicated it as a marker of severe infection, associated with positive blood cultures, increased risk of intensive care unit ICU and telemetry unit admission and longer hospital stays.[2] Presently, the lactic acid estimations have been included in the diagnostic criteria of the Sepsis Obstetrics Score (SOS) and Surviving Sepsis Campaign care bundles. [3,6] Low-income countries have high burdens of morbidity and mortality related to PAS. The increasing severity of PAS worsens the maternal prognosis, and therefore there is a strong need to develop parameters for its identification to optimise outcomes. Lactic acid level is one index that is currently being researched for its role in PAS. We therefore conducted this study with the aim of quantifying the severity of PAS using lactic acid levels. We also compared the culture positivity in obstetrics sepsis with lactic acid levels, to try to find a possible association between them. MethodsEthics clearance was obtained from the Institutional Ethical Committee and prior consent was obtained from all patients. All pregnant, post-abortal (2 weeks) and postpartum women (up to 6 weeks) with clinical sepsis were investigated using systemic inflammatory response syndrome cr...

Serial Serum Lactic Acid in Pregnancy-Associated Sepsis for Maternal Outcome

“…Rise in lactic acid at 48 h (Ratio > 1) was found to be statistically significant to predict mortality (p value = 0.045). In our study, the mortality rate in the lactate clearance group was 17% and in the nonclearance group was 37% which was consistent with the findings of a study by Bhatt et al [8] according to which mortality rate in the lactate clearance group was 15.2% as compared to 36.1% in the lactate nonclearance group. When lactic acid clearance was PAS subjects with lactate clearance ≥ 60% at 48 h, whereas all cases with a 100% rise in lactic acid had mortality.…”

“…In our study, 96.8% PAS cases admitted to ICU had lactic acid levels more than equal to 2 mmol/l and 78% had lactic acid more than equal to 4 mmol/l. Similarly, Agarwal et al [8] had found that a cut-off of 4 mmol/l had a sensitivity of 37.9%, specificity of 88.1% and positive predictive value of 81.4% for the severity of PAS. Hence, from our study, it was postulated that lactic acid value of 2 mmol/l and 4 mmol/l had a sensitivity of 96.9%,78% and specificity of 23%, 68.1% for ICU admission, respectively.…”