Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study

Abstract

Background: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, the clinical picture alone is not sufficient for assessing disease severity and outcomes. Because blood lactate level is included in the clinical criteria of SS it should be considered to improve the assessment of its severity. This study aims to investigate the relationship between pre-hospital blood lactate level and 30-day mortality in patients with SS. Methods: From 15 April 2017 to 15 April 2019, patients with SS requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were prospectively included in the LAPHSUS study, an observational, non-randomized controlled study. Pre-hospital blood lactate levels were measured at the time of first contact between the patients and the MICU. Results: Among the 183 patients with septic shock requiring action by the MICU drawn at random from LAPHSUS study patients, six (3%) were lost to follow-up on the 30th day and thus 177 (97%) were analyzed for blood lactate levels (mean age 70 ± 14 years). Pulmonary, urinary and digestive infections were probably the cause of the SS in respectively 58%, 21% and 11% of the cases. The 30-day overall mortality was 32%. Mean pre-hospital lactatemia was significantly different between patients who died and those who survived (respectively 7.1 ± 4.0 mmol/L vs. 5.9 ± 3.5 mmol/L, p < 10−3). Using Cox regression analysis adjusted for potential confounders we showed that a pre-hospital blood lactate level ≥ 4 mmol/L significantly predicted 30-day mortality in patients with SS (adjusted hazard ratio = 2.37, 95%CI (1.01–5.57), p = 0.04). Conclusion: In this study, we showed that pre-hospital lactatemia predicts 30-day mortality in patients with septic shock handled by the MICU. Further studies will be needed to evaluate if pre-hospital lactatemia alone or combined with clinical scores could affect the triage decision-making process for those patients.

Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis

“…Also, most of them provided data on the association between nonsepsis, sepsis, severe sepsis and septic shock and different blood lactate values. Meanwhile, there were 82 studies that demonstrated the relationship between blood lactate and sepsis induced mortality [9,11,15,19,31,34,36,[38][39][40][42][43][44][45][46][47][48][49][50][51]53,55,58,59,62,63,65,[67][68][69][70][71][72][74][75][76]78,81,83,85,[87][88][89]91,93,95,. Additionally, there were 46 articles reported the diagnostic accuracy of blood lactate levels in determining sepsis and associated clinical prognosis [11,15,31,33,34,38,43-45,50,53,56,59,64-67,69...…”

Admission Lactate Concentration, Base Excess, and Alactic Base Excess Predict the 28-Day Inward Mortality in Shock Patients

“…A direct comparison of our findings with other studies is problematic. Lactate and BE are routinely measured in critically ill patients suffering from various diseases, and both serve as mortality predictors in ICU (for example, in post-cardiac surgery patients or those with cardiogenic shock, ruptured abdominal aortic aneurysms, or trauma) [ 4 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Whether BE or lactate concentrations serve as better predictors of mortality in critical care patients has not yet been determined [ 4 , 33 , 34 , 35 , 36 ], with no studies reporting with certainty whether these predictors are both independent and/or additive.…”