Peritonitis‐associated hyperlactatemia for evaluating mortality in secondary peritonitis

Abstract

Background: In sepsis, lactate measurements correlate with mortality; however, the role of lactate in predicting mortality in patients of secondary peritonitis is not yet fully established. Methods: Data were maintained prospectively on 224 patients of secondary peritonitis over a period of 10 years. Arterial lactate measurements were performed twice in each patientonce, initially on admission (AL I) and the other, 24 h after surgery (AL 24); from these values, percentage lactate clearance was calculated. These lactate indices and other demographic factors were correlated with mortality. Results: Overall mortality was 16.07% (36 patients) and morbidity was 63.39% (pulmonary complications commonest); preoperative lactate (more than 2.35 mmol/L), 24-h postoperative lactate (more than 2.05 mmol/L), need for vasopressors and mechanical ventilation independently correlated with morbidity and mortality. A simple prognostic scale constructed using cutoff values of AL I , AL 24 , need for vasopressor support and mechanical ventilation showed a sensitivity of 97.22% and specificity of 52.13% for predicting mortality. Conclusion: Preoperative and postoperative arterial lactate levels, need for vasopressors and mechanical ventilation, are independent predictors of mortality. Using these parameters, it may be possible to identify high risk patients that can benefit from early, goal directed therapy to reduce the mortality of secondary peritonitis.

Evaluation of Serum Lactate, pH and Procalcitonin Level as a Prognostic Indicator for Mortality among Secondary Peritonitis Patients in a Tertiary Care Hospital

“…Although increased blood lactate levels have been documented as a risk factor for mortality in peritonitis. 9 Lactate levels are routinely used to assess circulatory function and tissue perfusion. Higher levels are thought to be associated with circulatory dysfunction and impaired tissue perfusion.…”

A Scale for Predicting of the Complications in Patients With Acute Peritonitis

“…Це дозволяє застосовувати адекватні профілактичні заходи. Донині запропоновано багато методів прогнозування, підґрунтям яких є різні критерії [1,2,3,[5][6][7]. Утім, жоден із знаних прогностичних методів не знайшов достатнього визнання.…”