Sequential blood lactate measurement as a predictor of mortality in patients with sepsis in the critical care unit

Abstract

Background and objectiveIn severe sepsis, increased blood lactate levels are observed indicating impaired oxidative phosphorylation, which secondarily causes hypoxic hypoxia and stagnant tissue hypoxia. Among all other related factors, a high rise of the lactate level in blood may be a useful predictor of sepsis patients' mortality. This study aims to determine the association of consecutive blood lactate levels with the patient's mortality with sepsis admitted in the Critical Care Unit (CCU). MethodsThis prospective study included 50 patient of septicemia at CCU above 18 years in a tertiary care centre. On admission, at 24 hours and 72 hours, blood lactate levels were monitored. Their clinical status was evaluated for 28 days to categorise as survivor and non-survivor. The statistical analysis was made with Microsoft Excel and SPSS version 20. To test the difference in mean blood lactate levels among survivors and non-survivors Student’s t-test was applied. A p-value of less than 0.05 was considered significant. Prior ethical clearance from the institutional ethics committee of human with informed consent from the patients was obtained for data collection.ResultsThe current study included 50 patients of septicemia, 23 were survivors, and 27 were non-survivors after 28 days of follow up. The mean lactate range for the 23 survivors was ranged from 0.43 mmol/l to 5.69 mmol/l, whereas for non-survivors, it was 1.64 mmol/l to 6.14 mmol/l. The mean value of lactate for the survivors and non-survivors during admission, at 24 hours and at 72 hours were 0.9545±0.45798 vs 2.5204±1.51498, 1.2461±1.21360 vs 2.5107±1.63678 and 1.5496±1.66788 vs 2.7904±2.00160. The differences between the mean lactate values between survivors and non-survivors at different time intervals were highly significant.ConclusionA slower rate of lactate clearance during hospitalisation may be a significant factor associated with severe sepsis patient mortality. Thus serial blood lactate levels is a significant predictor of mortality and should be monitored.