Acute Crit Care.  2019 May;34(2):126-132. 10.4266/acc.2018.00283.

Utility of the early lactate area score as a prognostic marker for septic shock patients in the emergency department

Affiliations
  • 1Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. chrisryoo@amc.seoul.kr

Abstract

BACKGROUND
The current Surviving Sepsis Campaign guidelines recommend the remeasurement of lactate levels if the initial lactate level is elevated; however, the prognostic value of lactate kinetics is limited and inconsistent. We attempted to determine the efficacy of the lactate area score (calculated from repeated lactate measurements during initial resuscitation) as a prognostic marker of septic shock in the emergency department (ED).
METHODS
We performed a retrospective study of adult patients with septic shock in the ED of a single tertiary medical center. Serial lactate levels were measured five times within 12 hours. We also compared the initial lactate level, maximum lactate level, and lactate area score. The lactate area score was defined as the sum of the area under the curve measured at 2, 4, 6, and 12 hours following the initial measurement.
RESULTS
A total of 362 patients were enrolled in this study, and the overall 28-day mortality was 31.8%. The lactate area score of serial lactate levels as well as the initial (median [interquartile range], 4.9 [3.4 to 10.5]; P=0.003) and maximum (7.3 [4.2 to 13.2]; P<0.001) lactate levels were significantly higher in the non-survivor group. However, in multivariate analysis, only the lactate area score (odds ratio, 1.013; 95% confidence interval, 1.007 to 1.019) was significantly associated with 28-day mortality.
CONCLUSIONS
The early lactate area score may be a possible prognostic marker for predicting the 28-day mortality of adult septic shock patients. Further prospective interventional studies should be conducted to validate our results.

Keyword

lactic acid; mortality; prognosis; sepsis; shock

MeSH Terms

Adult
Emergencies*
Emergency Service, Hospital*
Humans
Kinetics
Lactic Acid*
Mortality
Multivariate Analysis
Prognosis
Prospective Studies
Retrospective Studies
Sepsis
Shock
Shock, Septic*
Lactic Acid

Figure

  • Figure 1. Flowchart of the selection and classification of patients.

  • Figure 2. Receiver operating characteristic and area under the curve (AUC) in lactate area score, maximum lactate, and initial lactate.


Cited by  2 articles

Recent lactate findings: is repeated serum lactate testing necessary in septic shock patients?
Moo Suk Park
Acute Crit Care. 2019;34(2):155-157.    doi: 10.4266/acc.2019.00528.

Usefulness of presepsin in predicting the prognosis of patients with sepsis or septic shock: a retrospective cohort study
Jeong Suk Koh, Yoon Joo Kim, Da Hyun Kang, Jeong Eun Lee, Song-I Lee
Yeungnam Univ J Med. 2021;38(4):318-325.    doi: 10.12701/yujm.2021.01018.


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