• Journal of critical care · Feb 2017

    Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock.

    • Sharukh Lokhandwala, Lars W Andersen, Sunil Nair, Parth Patel, Michael N Cocchi, and Michael W Donnino.
    • Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA; Massachussetts Institute of Technology, Cambridge, MA; Department of Medicine, Division of Pulmonary and Critical Care, University of Washington, Seattle, WA. Electronic address: slokhand@uw.edu.
    • J Crit Care. 2017 Feb 1; 37: 179-184.

    PurposeLactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4mmol/L, we compared mortality prediction between a subsequent lactate ≥4mmol/L to a <10% and <20% decrease between initial and subsequent lactate values.Materials And MethodsWe performed a single-center retrospective study of patients presenting to the emergency department with an initial lactate ≥4mmol/L and suspected infection. Patients were stratified by lactate reduction using 3 previously identified definitions (subsequent lactate ≥4mmol/L, and <10% and <20% relative decrease in lactate) and compared using multivariable logistic regression. Sensitivity and specificity were compared using McNemar test.ResultsA subsequent lactate ≥4mmol/L and a lactate reduction <20% were associated with increased in-hospital mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.24-8.16; P=.02 and OR, 3.11; 95% CI, 1.39-6.96; P=.006, respectively), whereas a lactate reduction <10% was not (OR, 1.13; 95% CI, 0.94-1.34; P=.11). A subsequent lactate ≥4mmol/L and a lactate reduction <20% were more sensitive than a lactate reduction <10% (72% vs 41%, P=.002 and 62% vs 41%, P=.008, respectively) but less specific (57% vs 76%, P<.001 and 67% vs 76%, P=.002, respectively).ConclusionsA subsequent lactate ≥4mmol/L and lactate reduction <20% were associated with increased in-hospital mortality, whereas a lactate reduction <10% was not. Sensitivity and specificity are different between these parameters.Copyright © 2016 Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.