Initial lactate level and mortality in septic shock patients with hepatic dysfunction.

Area of Science:

• Critical Care Medicine
• Biochemistry
• Clinical Pathology

Background:

• Elevated serum lactate is linked to mortality in severe sepsis and septic shock.
• Hepatic dysfunction complicates lactate interpretation due to impaired clearance or overproduction.
• The prognostic value of initial lactate in septic shock with hepatic dysfunction requires clarification.

Purpose of the Study:

• To determine if initial serum lactate levels predict mortality in septic shock patients with hepatic dysfunction.
• To assess the utility of lactate as a prognostic marker irrespective of liver function.

Main Methods:

• Retrospective observational study of 307 septic shock patients admitted to the ICU.
• Hepatic dysfunction defined as serum total bilirubin > 34.2 micromol/l (2 mg/dl).
• Patients categorized into high (>= 4 mmol/l) and low (< 4 mmol/l) initial lactate groups.

Main Results:

• 118 patients had hepatic dysfunction.
• Initial serum lactate was strongly associated with in-hospital mortality (univariate analysis, P < 0.001).
• Lactate remained a significant predictor of mortality after adjusting for confounders (OR 1.281, P = 0.002).

Conclusions:

• Initial serum lactate levels are valuable for predicting outcomes in septic shock patients.
• Lactate's prognostic utility persists even in the presence of hepatic dysfunction.