Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis

Abstract

Background Sepsis is a common critical condition caused by the body’s overwhelming response to certain infective agents. Many biomarkers, including the serum lactate level, have been used for sepsis diagnosis and guiding treatment. Recently, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) recommended the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) rather than lactate for screening sepsis and assess prognosis. Here, we aim to explore and compare the prognostic accuracy of the lactate level, the SOFA score and the qSOFA score for mortality in septic patients using the public Medical Information Mart for Intensive Care III database (MIMIC III). Methods The baseline characteristics, laboratory test results and outcomes for sepsis patients were retrieved from MIMIC III. Survival was analysed by the Kaplan-Meier method. Univariate and multivariate analysis was performed to identify predictors of prognosis. Receiver operating characteristic curve (ROC) analysis was conducted to compare lactate with SOFA and qSOFA scores. Results A total of 3713 cases were initially identified. The analysis cohort included 1865 patients. The 24-h average lactate levels and the worst scores during the first 24 h of ICU admission were collected. Patients in the higher lactate group had higher mortality than those in the lower lactate group. Lactate was an independent predictor of sepsis prognosis. The AUROC of lactate (AUROC, 0.664 [95% CI, 0.639–0.689]) was significantly higher than that of qSOFA (AUROC, 0.547 [95% CI, 0.521–0.574]), and it was similar to the AUROC of SOFA (AUROC, 0.686 [95% CI, 0.661–0.710]). But the timing of lactate relative to SOFA and qSOFA scores was inconsistent. Conclusion Lactate is an independent prognostic predictor of mortality for patients with sepsis. It has superior discriminative power to qSOFA, and shows discriminative ability similar to that of SOFA. Electronic supplementary material The online version of this article (10.1186/s13049-019-0609-3) contains supplementary material, which is available to authorized users.

Lactate Suppresses Macrophage Pro-Inflammatory Response to LPS Stimulation by Inhibition of YAP and NF-κB Activation via GPR81-Mediated Signaling

“…Accumulation of lactate in the tissue microenvironment is also a feature of sepsis ( 10 ). It has been indicated that the physiological lactate concentration in blood or healthy tissues is approximately 1.5 – 3 mM ( 39 ), while the blood lactate levels in septic patients can reach over 20 mM ( 40 ). Remarkably, lactate levels can rise to 40 mM at the inflamed tissues ( 39 ).…”

Assessment of pSOFA-L score in predicting the clinical outcome of critically ill children

“…A study prognostic accuracy of serum lactate level, the SOFA score and qSOFA score for mortality among adults with sepsis conducted by Zhiqiang Liu, Zibo et al, documented that higher the lactate level poorer the outcome interms of mortality in sepsis patients. 16 Serum Lactate level is considered as a key tool in assessing the metabolic acidosis, hypoxia at tissue level which is mediated by shock either it can be septic shock or hypovolemic or cardiogenic shock. Increase in lactate levels is associated with multi-organ dysfunction and predicts the outcome in terms of length of hospital stay and mortality.…”

Vasopressin in Conjunction With Norepinephrine in Septic Shock: A Retrospective Cohort Study From a Low Middle-Income Country

“…Lower lactate levels with greater lactate clearance have consistently been associated with improved outcomes and lower mortality ( 19 – 21 ). In fact, a recent study by Liu et al ( 22 ) found lactate to be an independent predictor for mortality in septic patients. This has been substantiated by our study’s results, which demonstrated that higher mortality was not due to the vasopressor combination itself but rather due to the higher admission lactate level which was independently associated to the norepinephrine-vasopressin group.…”