Monday, April 27, 2009

Monday April 27, 2009
Lactic acid level is still very relevant

Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis. Objective of this study to test whether the association between initial serum lactate level and mortality in patients presenting to the emergency department (ED) with severe sepsis is independent of organ dysfunction and shock. It was a single-center cohort study of 830 patients at an ED of an academic tertiary care center from 2005 to 2007. who were admitted with severe sepsis.

The primary outcome: 28-day mortality

Risk factor variable: Initial venous lactate (mmol/L), categorized as

  • low (less than 2),
  • intermediate (2-3.9), or
  • high (more than/=4)

Potential covariates: age, sex, race, acute and chronic organ dysfunction, severity of illness, and initiation of early goal-directed therapy.


Results:
  • Mortality at 28 days was 22.9% and
  • Median serum lactate was 2.9 mmol/L.
  • Intermediate and high serum lactate levels were associated with mortality in the nonshock subgroup.
  • In the shock subgroup, intermediate and high serum lactate levels were also associated with mortality.

Conclusions: Initial serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients admitted to the ED with severe sepsis. Both intermediate and high serum lactate levels were independently associated with mortality.



Reference: click to get abstract

Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock - Critical Care Medicine. 37(5):1670-1677, May 2009

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