J Korean Med Sci.  2023 Oct;38(40):e313. 10.3346/jkms.2023.38.e313.

The Association Between Tachycardia and Mortality in Septic Shock Patients According to Serum Lactate Level: A Nationwide Multicenter Cohort Study

• Na SJ
• Oh DK
• Park S
• Lee YJ
• Hong SB
• Park MH
• Ko RE
• Lim CM
• Jeon K
• obotKSA(I

• KMID: 2546931
• DOI: http://doi.org/10.3346/jkms.2023.38.e313

Abstract

Background
This study aimed to evaluate whether the effect of tachycardia varies according to the degree of tissue perfusion in septic shock.
Methods
Patients with septic shock admitted to the intensive care units were categorized into the tachycardia (heart rate > 100 beats/min) and non-tachycardia (≤ 100 beats/min) groups. The association of tachycardia with hospital mortality was evaluated in each subgroup with low and high lactate levels, which were identified through a subpopulation treatment effect pattern plot analysis.
Results
In overall patients, hospital mortality did not differ between the two groups (44.6% vs. 41.8%, P = 0.441), however, tachycardia was associated with reduced hospital mortality rates in patients with a lactate level ≥ 5.3 mmol/L (48.7% vs. 60.3%, P = 0.030; adjusted odds ratio [OR], 0.59, 95% confidence interval [CI], 0.35–0.99, P = 0.045), not in patients with a lactate level < 5.3 mmol/L (36.5% vs. 29.7%, P = 0.156; adjusted OR, 1.39, 95% CI, 0.82–2.35, P = 0.227).
Conclusion
In septic shock patients, the effect of tachycardia on hospital mortality differed by serum lactate level. Tachycardia was associated with better survival in patients with significantly elevated lactate levels.

Keyword

Septic Shock; Tachycardia; Lactate; Mortality; Cohort Studies; Multicenter Study

Figure

• 

  Fig. 1 Scheme of patient selectin and group distribution.ICU = intensive care unit.

• 

  Fig. 2 Subpopulation treatment effect pattern plot. A subpopulation treatment effect pattern plot of (A) the hospital mortality of patients with or without tachycardia according to subpopulations stratified according to the serum lactate level and (B) the differences in hospital mortality rate between patients with and without tachycardia according to subpopulations stratified according to the serum lactate level.

• 

  Fig. 3 Hospital mortality according to the lactate level. The hospital mortality rate of the non-tachycardia (blue bar) and tachycardia (red bar) groups according to the lactate level in the (A) overall patients and (B) propensity-matched patients.

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