Serial Serum Lactic Acid in Pregnancy-Associated Sepsis for Maternal Outcome

Goyal, Penzy; Agarwal, Rachna; Srivastava, Himsweta; Kar, Rajarshi; Sikka, Meera; Mohta, Medha

doi:10.1007/s13224-020-01348-y

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…In addition, half of our hypotensive, septic women did not receive volume resuscitation, and vasopressor agents were administered in only 9.5% of cases. Worse outcomes have also been reported in septic women with increased serum lactate levels, an indicator of cellular stress and illness severity, thus suggesting the clinical relevance of their assessment and early correction [ 44 , 45 ]. Such evaluation was missing in 30.6% of our women.…”

Section: Discussionmentioning

confidence: 99%

Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study

Ornaghi

Maraschini²,

Buoncristiano³

et al. 2022

Microorganisms

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Maternal sepsis represents a leading cause of mortality and severe morbidity worldwide. In Italy, it is the second cause of direct maternal mortality. Delay in recognition and treatment initiation are the drivers of sepsis-associated adverse outcomes. Between November 2017 and October 2019, the Italian Obstetric Surveillance System coordinated a prospective population-based study on maternal sepsis occurring before or after childbirth from 22 weeks’ gestation onward and up to 42 days following the end of pregnancy. A nested 1:2 matched case-control study on postpartum sepsis was also performed. Maternal sepsis was diagnosed for the presence of suspected or confirmed infection alongside signs or symptoms of organ failure. The aim of this study was to assess maternal sepsis incidence and its associated risk factors, management, and perinatal outcomes. Six Italian regions, covering 48.2% of the national births, participated in the project. We identified an incidence rate of 5.5 per 10,000 maternities (95% CI 4.80–6.28). Seventy percent of patients had a low education level and one third were foreigners with a language barrier. Genital, respiratory, and urinary tract infections were the predominant sources of infection; the majority of cases was caused by E. coli and polymicrobial infections. The presence of vascular and indwelling bladder catheters was associated with a nine-fold increased risk of postpartum sepsis. There were no maternal deaths, but one fourth of women experienced a serious adverse event and 28.3% required intensive care; 1.8% of newborns died. Targeted interventions to increase awareness of maternal sepsis and its risk factors and management should be promoted.

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Section: Discussionmentioning

confidence: 99%

Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study

Ornaghi

Maraschini²,

Buoncristiano³

et al. 2022

Microorganisms

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“…Further to this, there is some evidence for the use of lactate in guiding sepsis therapy 47–49. Lactate levels have been shown to correlate with disease severity, and increased lactate clearance has long been known to correlate with survivability 47 49–51. Using lactate kinetics as part of lactate clearance-driven therapy could improve patient outcomes 52–55.…”

Section: Discussionmentioning

confidence: 99%

Does lactate enhance the prognostic accuracy of the quick Sequential Organ Failure Assessment for adult patients with sepsis? A systematic review

et al. 2022

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ObjectivesTo investigate whether adding lactate to the quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) improves the prediction of mortality in adult hospital patients, compared with qSOFA alone.DesignSystematic review in accordance with Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines.Data sourcesEmbase, Medline, PubMed, SCOPUS, Web of Science, CINAHL and Open Grey databases were searched in November 2020.Eligibility criteriaOriginal research studies published after 2016 comparing qSOFA in combination with lactate (LqSOFA) with qSOFA alone in adult patients with sepsis in hospital. The language was restricted to English.Data extraction and synthesisTitle and abstract screening, full-text screening, data extraction and quality assessment (using Quality Assessment of Diagnostic Accuracy Studies-2) were conducted independently by two reviewers. Extracted data were collected into tables and diagnostic test accuracy was compared between the two tests.ResultsWe identified 1621 studies, of which 11 met our inclusion criteria. Overall, there was a low risk of bias across all studies. The area under the receiver operating characteristic (AUROC) curve for qSOFA was improved by the addition of lactate in 9 of the 10 studies reporting it. Sensitivity was increased in three of seven studies that reported it. Specificity was increased in four of seven studies that reported it. Of the six studies set exclusively within the emergency department, five published AUROCs, all of which reported an increase following the addition of lactate. Sensitivity and specificity results varied throughout the included studies. Due to insufficient data and heterogeneity of studies, a meta-analysis was not performed.ConclusionsLqSOFA is an effective tool for identifying mortality risk both in adult inpatients with sepsis and those in the emergency department. LqSOFA increases AUROC over qSOFA alone, particularly within the emergency department. However, further original research is required to provide a stronger base of evidence in lactate measurement timing, as well as prospective trials to strengthen evidence and reduce bias.PROSPERO registration numberCRD42020207648.

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“…Furthermore, the presence of asymmetric distribution in funnel plots, as indicated by Deek's test (p = 0.00), raised the possibility of publication bias within the studies (Figure 5). sis between blood lactate levels and mortality [11,15,31,33,34,38,[43][44][45]50,53,56,59,[64][65][66][67][69][70][71][72]77,78,85,89,100,102,103,[106][107][108]110,111,114,117,121,122,124,[133][134][135][136][137][138][139][140].…”

Section: High Level Blood Lactate Demonstrated a Sufficient Prognosti...mentioning

confidence: 99%

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

Zhu,

Zhou,

Qin

et al. 2024

Biomedicines

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Background: Blood lactate is a potentially useful biomarker to predict the mortality and severity of sepsis. The purpose of this study is to systematically review the ability of lactate to predict hierarchical sepsis clinical outcomes and distinguish sepsis, severe sepsis and septic shock. Methods: We conducted an exhaustive search of the PubMed, Embase and Cochrane Library databases for studies published before 1 October 2022. Inclusion criteria mandated the presence of case–control, cohort studies and randomized controlled trials that established the association between before-treatment blood lactate levels and the mortality of individuals with sepsis, severe sepsis or septic shock. Data was analyzed using STATA Version 16.0. Results: A total of 127 studies, encompassing 107,445 patients, were ultimately incorporated into our analysis. Meta-analysis of blood lactate levels at varying thresholds revealed a statistically significant elevation in blood lactate levels predicting mortality (OR = 1.57, 95% CI 1.48–1.65, I2 = 92.8%, p < 0.00001). Blood lactate levels were significantly higher in non-survivors compared to survivors in sepsis patients (SMD = 0.77, 95% CI 0.74–0.79, I2 = 83.7%, p = 0.000). The prognostic utility of blood lactate in sepsis mortality was validated through hierarchical summary receiver operating characteristic curve (HSROC) analysis, yielding an area under the curve (AUC) of 0.72 (95% CI 0.68–0.76), accompanied by a summary sensitivity of 0.65 (95% CI 0.59–0.7) and a summary specificity of 0.7 (95% CI 0.64–0.75). Unfortunately, the network meta-analysis could not identify any significant differences in average blood lactate values’ assessments among sepsis, severe sepsis and septic shock patients. Conclusions: This meta-analysis demonstrated that high-level blood lactate was associated with a higher risk of sepsis mortality. Lactate has a relatively accurate predictive ability for the mortality risk of sepsis. However, the network analysis found that the levels of blood lactate were not effective in distinguishing between patients with sepsis, severe sepsis and septic shock.

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Serial Serum Lactic Acid in Pregnancy-Associated Sepsis for Maternal Outcome

Cited by 11 publications

References 10 publications

Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study

Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study

Does lactate enhance the prognostic accuracy of the quick Sequential Organ Failure Assessment for adult patients with sepsis? A systematic review

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

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