• Zhongheng Zhang, Xiao Xu, and Kun Chen.
• Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Zhejiang, People's Republic of China.
• BMJ Open. 2014 May 23; 4 (5): e004752.

IntroductionArterial lactate is a reflection of balance between lactate production and clearance. Accumulating lactate may be a marker of global hypoxia or hypoperfusion. Lactate clearance is the reduction of lactate concentrations with interventional strategies, and it has been associated with increased risk of death in critically ill patients. However, conflicting results exist, which mandates a systematic review to clarify the association between lactate clearance and clinical outcome.Methods And AnalysisCritically ill adult patients will be included in our analysis. This population will include heterogeneous study participants, including patients with sepsis or severe sepsis, trauma, surgical intensive care unit (ICU) patients, and so on. We will search four databases including EBSCO, PubMed, Scopus and ISI Web of knowledge from inception to February 2014. There will be no language restrictions in the electronic search for studies. Newcastle Ottawa Scale for cohort study will be employed to assess the reporting quality of included original studies. We will report pooled relative risk of death for those with lactate clearance and those without. The diagnostic performance of lactate clearance in predicting mortality will be explored by using the hierarchical summary receiver operating characteristic model.Ethics And DisseminationThe protocol for the systematic review has been registered in PROSPERO. The study will be disseminated electronically and in print. It will also be presented to conferences related to critical care medicine.Trial Registration NumberCRD42013006511.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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