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Normal-range blood lactate concentration in septic shock is prognostic and predictive
Petch Wacharasint1, Taka-aki Nakada, John H Boyd
1University of British Columbia, Critical Care Research Laboratories, Institute for Heart+Lung Health, St Paul's Hospital, Vancouver, British Columbia, Canada.
Shock (Augusta, Ga.)
|May 4, 2012
Summary
Lactate levels within the normal range are prognostic for septic shock patients. Low lactate levels (≤ 1.4 mmol/L) indicate a better response to vasopressin infusion compared to noradrenaline.
Area of Science:
- Critical Care Medicine
- Biochemistry
- Clinical Research
Background:
- Elevated lactate is a known marker for mortality in septic shock.
- The prognostic value of lactate levels within the normal range remains less understood.
Purpose of the Study:
- To investigate if lactate levels, even within the normal range, are prognostic in septic shock.
- To determine if low lactate levels predict a beneficial response to vasopressin infusion.
Main Methods:
- Retrospective analysis of two septic shock cohorts (VASST and SPH).
- Lactate levels divided into quartiles; 28-day mortality as primary outcome.
- Receiver operating characteristic (ROC) curve analysis used to compare lactate and APACHE II scores for prognosis.
Main Results:
- Lactate levels between 1.4 and 2.3 mmol/L (second quartile) showed significantly increased mortality and organ dysfunction.
- Baseline lactate values demonstrated prognostic accuracy comparable to APACHE II scores.
- Lactate concentrations ≤ 1.4 mmol/L predicted a beneficial response to vasopressin versus noradrenaline.
Conclusions:
- Lactate concentrations within the normal range serve as a valuable prognostic indicator in septic shock.
- Patients with lactate levels ≤ 1.4 mmol/L may experience greater benefit from vasopressin infusion.
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