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Lactate clearance and mortality in septic patients with hepatic dysfunction
Tae Sun Ha1, Tae Gun Shin2, Ik Joon Jo2
1Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
The American Journal of Emergency Medicine
|March 16, 2016
Summary
Lactate clearance (LC) in septic patients with liver dysfunction is a useful predictor of hospital mortality. Lower LC at 6 and 24 hours indicates higher mortality risk, with 24-hour LC showing better predictive power.
Area of Science:
- Critical Care Medicine
- Sepsis Pathophysiology
- Hepatic Dysfunction
Background:
- Serum lactate clearance (LC) is a prognostic marker in sepsis.
- Its utility in septic patients with hepatic dysfunction, which can affect lactate metabolism, is uncertain.
Purpose of the Study:
- To evaluate the association between LC and hospital mortality in septic patients with hepatic dysfunction.
Main Methods:
- Analyzed data from 770 patients with severe sepsis or septic shock.
- Included 208 patients with hepatic dysfunction.
- Used multiple logistic regression to assess LC at 6 and 24 hours against hospital mortality.
Main Results:
- Lower LC at 6 and 24 hours was significantly associated with in-hospital mortality.
- Adjusted odds ratios for mortality were 4.940 at 6h and 5.997 at 24h for low LC.
- LC at 24 hours demonstrated superior discriminatory power (AUC 0.704) compared to LC at 6 hours (AUC 0.608).
Conclusions:
- Lactate clearance is a valuable prognostic indicator in septic patients with hepatic dysfunction.
- 24-hour lactate clearance offers better prediction of outcomes than 6-hour clearance.
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