Title: A Study to Assess Lactate Clearance for Death Prediction in Severe Sepsis or Septic Shock Patients in Intensive Care Unit-KIMS Hospital, Bengaluru
Authors: Dr R. Vedavathi, Dr Varun Manjunath, Dr Vinay Babu C. S., Dr Rajesh Kiran K. V., Dr Sini R. Krishnan, Dr Shashidhar V, Dr Mahati Dasari
DOI: https://dx.doi.org/10.18535/jmscr/v6i11.100
Abstract
Aims and Objective: To determine the significance of lactate clearance in sepsis and its association with morbidity and mortality in sepsis, at KIMS Hospital Bengaluru.
Materials and Methods: A total of 100 patients with age more than 18 years with sepsis in the duration of 18 months (December 2016 - May 2018) were included in this retrospective observational study. Other causes of shock not due to sepsis were ruled out, serial Arterial Blood Gas Analysis and 0,6 and 24 hours were drawn respectively. Lactate clearance, Acute Physiology and Chronic Health Evaluation was calculated and the outcome was observed.
Measurements and Main Results: One hundred patients were enrolled with mean age 52±10yrs, overall in-hospital mortality rate 32%. Baseline APACHE II score was 18±4and lactate 6.6±3.6 mmol/L. Survivors compared with nonsurvivors had a lactate clearance of 36.1±30 vs. 10.0±40.8 respectively (p =.005). Multivariate logistic regression analysis of statistically significant univariate variables showed lactate clearance to have a significant inverse relationship with mortality (p =0.04). There was an approximately 14% decrease likelihood of mortality for each 10% increase in lactate clearance. Patients with a lactate clearance >10%, relative to patients with a lactate clearance <10%, had a greater decrease in APACHE II score and mortality.
Conclusions: Patients with higher lactate clearance after 6 hrs of intensive care unit intervention have improved outcome compared with those with lower lactate clearance.
Keywords: Lactate clearance, septic shock, resuscitation, hypoxia, severe sepsis.
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