Lactate levels as a predictor of mortality in patients with septic shock
Main Article Content
Keywords
Serum lactate, Septic shock, Mortality
Abstract
Background: The objective was to determine the association between serum lactate levels and mortality in patients with septic shock in the Emergency Room of the Instituto Mexicano del Seguro Social’s Centro Médico Nacional Adolfo Ruiz Cortines.
Methods: We included the patients admitted to the Emergency Room with diagnosis of septic shock who had measure of serum lactate at admission during the period 01-12/2013; it was a case-control study. The cut-off value of serum lactate associated with mortality was performed using the ROC (receiver operating characteristic) curves.
Results: Sixty-seven patients were studied, out of which 56 survived (cases) and 11 died (controls). There was no association with gender, age and comorbidities. The cut-off value for mortality of serum lactate was 4.9 mmol/L. Ten patients out of 40 with lactate levels > 4.9 mmol/L, and only one out of 27 with lactate < 4.9 mmol/L died (p = 0.04); odds ratio was of 8.7. The mortality in patients with septic shock and lactate > 4.9mmol/ is high and had a sensitivity of 90.9 % and specificity of 46.4 %.
Conclusions: The levels of serum lactate greater than four are associated to an increased risk of mortality in patients with septic shock.
References
Vernon C, Letourneau JL. Lactic acidosis: recognition, kinetics and associated prognosis. Crit Care Clin. 2010;26(2):255-83. Texto libre en http://www.sciencedirect.com/science/article/pii/S0749070409001328
Hollenberg SM. Inotrope and vasopressor therapy of septic shock. Crit Care Clin. 2009;25(4):781-802. Texto libre en http://www.sciencedirect.com/science/article/pii/S0749070409000633
Molano Trujillo M. Lactato en la práctica clínica. Acta Col Cuidado Intens. 2008;8(4);370-4.
Morrell MR, Micek ST, Kollef MH. The management of severe sepsis and septic shock. Infect Dis Clin N Am. 2009;23:485-501. Texto libre en http://www.sciencedirect.com/science/article/pii/S0891552009000312
Guevara Ramirez P, Diaz Garcia R, Galán Ortega A, Guillén Campuzano E, Malumbres S, Marín Soria JL. Lactato: utilidad clínica y recomendaciones para su medición. Soc Esp Bioq Clin Patol Mol. 2012;183(11):8-16.
Nduka OO, Parrillo JE. The pathophysiology of septic shock. Crit Care Clin. 2009; 25(4):677-702. Texto libre en http://www.sciencedirect.com/science/article/pii/S0749070409000670
Acuña-Nieto O, Russi-Hernández M, Esquivel-Chávez A. Correlación de niveles séricos de lactato con la saturación venosa central de oxigeno como marcador de perfusión en pacientes con sepsis, sepsis severa y choque séptico. Arch Med Urg Mex. 2009;1(1):12-7.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaing: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637. doi: 10.1097/CCM.0b013e31827e83af.
Vernon C, Letorneau JL. Lactic acidosis: recognition, kinetics and associated prognosis. Crit Care Clin. 2010;26(2):255-83. Texto libre en http://www.sciencedirect.com/science/article/pii/S0749070409001328
Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45(5):524-8. Texto libre en http://www.sciencedirect.com/science/article/pii/S0196064404017494
Marino LP. El libro de la UCI. 3a ed. Barcelona, España: Wolters Kluwer: Lippincott Williams & Wilkins; 2007.
Revelly JP, Tappy L, Martinez A, Bollmann M, Cayeux MC, Berger MM, et al. Lactate and glucose metabolism in severe sepsis and cardiogenic shock. Crit Care Med. 2005;33(10):2235-40.