Outcomes of severe sepsis and septic shock patients after stratification by initial lactate value

Chambers, Kimberly A.; Park, Adam Y.; Banuelos, Rosa; Darger, Bryan; Akkanti, Bindu; Macaluso, Annamaria; Thangam, Manoj; Doshi, Pratik

doi:10.5847/wjem.j.1920-8642.2018.02.005

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…[6] In other words, the primary driver of mortality in sepsis is the systemic infl ammatory response, and this response is triggered by uncontrolled infection arising from a specifi c anatomical source, which may infl uence the progression and clinical outcome of sepsis. [7] Previous studies [8][9][10] have investigated the independent role of the anatomical site of infection with regard to mortality caused by sepsis, but with varying findings. SA-AKI patients have a high risk of mortality; previous studies [5,7,11,12] have shown that the most common source of infection is the lung, followed by the gastrointestinal and urinary tracts.…”

Section: Introductionmentioning

confidence: 99%

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

Fan

Jiang

Chen

et al. 2020

World Journal of Emergency Medicine

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BACKGROUND: Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury (SA-AKI) than among patients with sepsis. However, the pathogenesis underlying SA-AKI remains unclear. We hypothesized that the source of infection affects development of SA-AKI. We aim to explore the relationship between the anatomical source of infection and outcome in patients with SA-AKI. METHODS: Between January 2013 and January 2018, 113 patients with SA-AKI admitted to our Emergency Center were identifi ed and divided into two groups: those with pulmonary infections and those with other sources of infection. For each patient, we collected data from admission until either discharge or death. We also recorded the clinical outcome after 90 days for the discharged patients. RESULTS: The most common source of infection was the lung (52/113 cases, 46%), followed by gastrointestinal (GI) (25/113 cases, 22.1%) and urinary (22/113, 19.5%) sources. Our analysis showed that patients with SA-AKI had a significantly worse outcome (30/52 cases, P<0.001) and poorer kidney recovery (P=0.015) with pulmonary sources of infection than those infected by another source. Data also showed that patients not infected by a pulmonary source more likely experienced shock (28/61 cases, P=0.037). CONCLUSION: This study demonstrated that the source of infection infl uenced the outcome of SA-AKI patients in an independent manner. Lung injury may influence renal function in an asyet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.

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Section: Introductionmentioning

confidence: 99%

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

Fan

Jiang

Chen

et al. 2020

World Journal of Emergency Medicine

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“…Previous studies reported mortality rates of septic shock, cryptic and vasoplegic shock. 5,6,[14][15][16][17][18] Few studies reported that a mortality rate of vasoplegic shock was higher than that of cryptic shock. 18 However, there are differences of mortality rates, many observational studies showed a mortality rate of cryptic shock group (lactate level >4 mmol/L) was higher than that of vasoplegic shock and lower than that of septic shock.…”

Section: F I G U R E 1 Flow Diagram Of Patients Included In the Studymentioning

confidence: 99%

“…16 Hyperlactatemia was considered a predictor of mortality, regardless of the phenotypes of sepsis. 8,9,14,15,[19][20][21] So, it is necessary to confirm the validity of the Sepsis-3 definition by comparing mortality rates of patients with cryptic shock or vasoplegic shock who are excluded from this new definition of septic shock. Our study found significant variation in 28-day mortality among the three groups: 23.4% in the septic shock group, 8.8% in the vasoplegic shock group and 12.2% in the cryptic shock group (P < .001).…”

Section: F I G U R E 1 Flow Diagram Of Patients Included In the Studymentioning

confidence: 99%

“…This is consistent with a recent small observational study by Kimberly et al, which included 338 patients and reported that an initial lactic acid level >4 mmol/L was the only factor independently associated with increased mortality. 15 Rising lactate levels correlate with increasing severity of illness and are associated with increased mortality from sepsis and septic shock. 8,14,15,19,22 We also found that cryptic shock patients with normal to mildly elevated lactate levels are still at substantial risk.…”

Section: F I G U R E 1 Flow Diagram Of Patients Included In the Studymentioning

confidence: 99%

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A mortality analysis of septic shock, vasoplegic shock and cryptic shock classified by the third international consensus definitions (Sepsis‐3)

Yang

Kang

Jung

et al. 2020

Clinical Respiratory J

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Introduction This study aimed to compare the 28‐day mortality of patients with septic shock, defined by Sepsis‐3 criteria and patients with vasoplegic or cryptic shock who are excluded from this new definition. Objectives This retrospective observational study was performed using a tertiary emergency department's septic shock registry and investigated the records of patients managed between January 2010 and December 2015. In 2,138 total patients, 1004 (47.0%) had septic shock, 476 (22.2%) had vasoplegic shock and 655 (30.6%) had cryptic shock. Results There was significant variation in 28‐day mortality among the three groups: 23.4% for septic shock, 8.8% for vasoplegic shock and 12.2% for cryptic shock (P < .001). In subgroup analysis of cryptic shock or septic shock according to lactate levels (2‐3, 3‐4 and >4 mmol/L), the mortality rate increased as lactate increased (cryptic shock: 9.5%, 14.8% and 18.0%; septic shock: 18.6%, 22.6% and 27.0%, respectively; P < .001). Multivariable analysis revealed odds ratios for mortality of 0.31 (95% CI 0.22‐0.44; P < .001) for vasoplegic shock and 0.46 (95% CI 0.35‐0.61; P < .001) for cryptic shock relative to septic shock. Survival curve analysis showed significant differences among patients with septic shock, vasoplegic shock and cryptic shock (Log rank test: P < .0001). Conclusion The new septic shock definition may be useful for identifying high‐risk patients requiring intensive care. However, cryptic shock‐associated mortality increased to 18.0% as serum lactate increased, which suggests that some cryptic shock patients may also require intensive management.

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“…Ultrasound can be used to reliably detect increases in volume following successful resuscitation. [39][40][41][42] Finally, patients with acute decompensated heart failure require strict intravascular fluid monitoring. Krishnan et al [43] showed that providers could use ultrasound evaluation of the IVC diameter to predict a patient's response to diuretics independent of his/her baseline renal function.…”

Section: Assessment Of Corrected Fl Ow Timementioning

confidence: 99%

The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients

Pourmand¹,

Pyle²,

Yamane³

et al. 2019

World Journal of Emergency Medicine

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BACKGROUND: Volume resuscitation has only been demonstrated to be effective in approximately fifty percent of patients. The remaining patients do not respond to volume resuscitation and may even develop adverse outcomes (such as acute pulmonary edema necessitating endotracheal intubation). We believe that point-of-care ultrasound is an excellent modality by which to adequately predict which patients may benefi t from volume resuscitation. DATA RESOURCES: We performed a search using PubMed, Scopus, and MEDLINE. The following search terms were used: fluid responsiveness, ultrasound, non-invasive, hemodynamic, fluid challenge, and passive leg raise. Preference was given to clinical trials and review articles that were most relevant to the topic of assessing a patient's cardiovascular ability to respond to intravenous fl uid administration using ultrasound. RESULTS: Point-of-care ultrasound can be easily employed to measure the diameter and collapsibility of various large vessels including the inferior vena cava, common carotid artery, subclavian vein, internal jugular vein, and femoral vein. Such parameters are closely related to dynamic measures of fluid responsiveness and can be used by providers to help guide fluid resuscitation in critically ill patients. CONCLUSION: Ultrasound in combination with passive leg raise is a non-invasive, costand time-effective modality that can be employed to assess volume status and response to fluid resuscitation. Traditionally sonographic studies have focused on the evaluation of large veins such as the inferior vena cava, and internal jugular vein. A number of recently published studies also demonstrate the usefulness of evaluating large arteries to predict volume status.

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Outcomes of severe sepsis and septic shock patients after stratification by initial lactate value

Cited by 17 publications

References 23 publications

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

A mortality analysis of septic shock, vasoplegic shock and cryptic shock classified by the third international consensus definitions (Sepsis‐3)

The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients

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