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Timing of Repeated Lactate Measurement in Patients with Septic Shock at Emergency Department
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A3305 - Timing of Repeated Lactate Measurement in Patients with Septic Shock at Emergency Department
Author Block: H. Lee, S. Ryoo, Y. Kim, C. Sohn, D. Seo, W. Kim; Asan Medical Center, Seoul, Korea, Republic of.
Abstract
Rationale: Lactate is a physiologic marker of oxygen balance that has prognostic value for mortality in septic patients. Repeated blood lactate level after quantitative resuscitation can serve as a surrogate for the response to therapy and may be more predictive for mortality than the initial lactate value. The object of this study was to evaluate the prognostic value of lactate levels during the first 12 hours after shock recognition and to identify the timing for repeated blood lactate measurement in patients with septic shock defined by sepsis-3.
Methods: Retrospective cohort study using prospective data registry which enrolled 2,226 consecutive adult (≥18 years) septic shock patients was conducted between January 2010 and December 2015 at a tertiary care university-affiliated hospital emergency department. Blood lactate was measured at shock recognition, and after 2, 4, 6, and 12 hours (T0, T2, T4, T6, T12) during quantitative resuscitation. Prognostic value of lactate level for 28-day mortality was analyzed using multivariable logistic regression and receiver operating characteristic curve.
Results: A total of 829 septic shock patients defined by sepsis-3 definition, 211 died. The lactate level at each time were associated with increased 28-day mortality and lactate level at 6 hour had the most prognostic value [the area under the curve of T0=0.61; T2=0.65; T4=0.69; T6=0.72; T12=0.62, and Odds ratio of T0, 1.17(95% Confidential Interval(CI) 1.11-1.23); T2, 1.23(95% CI 1.17-1.30); T4, 1.30(95% CI 1.22-1.38); T6, 1.33(95% CI 1.26-1.42); T12, 1.24(95% CI 1.19-1.30)]. The optimal cut-off value of lactate for predicting mortality at 6hr was > 5.0 mmol/L [OR 4.90(95% CI 3.46-6.93)] and its sensitivity, specificity, positive and negative predictive value were 47.4%, 84.5%, 51.0%, and 82.5%.
Conclusion: During the first 12 hours from shock recognition, the best time point and cutoff-value of lactate for predicting mortality was > 5.0 mmol/L at 6hr.
Author Block: H. Lee, S. Ryoo, Y. Kim, C. Sohn, D. Seo, W. Kim; Asan Medical Center, Seoul, Korea, Republic of.
Abstract
Rationale: Lactate is a physiologic marker of oxygen balance that has prognostic value for mortality in septic patients. Repeated blood lactate level after quantitative resuscitation can serve as a surrogate for the response to therapy and may be more predictive for mortality than the initial lactate value. The object of this study was to evaluate the prognostic value of lactate levels during the first 12 hours after shock recognition and to identify the timing for repeated blood lactate measurement in patients with septic shock defined by sepsis-3.
Methods: Retrospective cohort study using prospective data registry which enrolled 2,226 consecutive adult (≥18 years) septic shock patients was conducted between January 2010 and December 2015 at a tertiary care university-affiliated hospital emergency department. Blood lactate was measured at shock recognition, and after 2, 4, 6, and 12 hours (T0, T2, T4, T6, T12) during quantitative resuscitation. Prognostic value of lactate level for 28-day mortality was analyzed using multivariable logistic regression and receiver operating characteristic curve.
Results: A total of 829 septic shock patients defined by sepsis-3 definition, 211 died. The lactate level at each time were associated with increased 28-day mortality and lactate level at 6 hour had the most prognostic value [the area under the curve of T0=0.61; T2=0.65; T4=0.69; T6=0.72; T12=0.62, and Odds ratio of T0, 1.17(95% Confidential Interval(CI) 1.11-1.23); T2, 1.23(95% CI 1.17-1.30); T4, 1.30(95% CI 1.22-1.38); T6, 1.33(95% CI 1.26-1.42); T12, 1.24(95% CI 1.19-1.30)]. The optimal cut-off value of lactate for predicting mortality at 6hr was > 5.0 mmol/L [OR 4.90(95% CI 3.46-6.93)] and its sensitivity, specificity, positive and negative predictive value were 47.4%, 84.5%, 51.0%, and 82.5%.
Conclusion: During the first 12 hours from shock recognition, the best time point and cutoff-value of lactate for predicting mortality was > 5.0 mmol/L at 6hr.
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