Peritonitis-associated hyperlactatemia for evaluating mortality in secondary peritonitis

Area of Science:

• Critical Care Medicine
• Surgical Infections
• Biomarkers in Sepsis

Background:

• Sepsis mortality is linked to lactate levels, but its predictive role in secondary peritonitis requires further investigation.
• Secondary peritonitis poses a significant mortality risk, necessitating improved prognostic tools.

Purpose of the Study:

• To establish the predictive value of arterial lactate measurements for mortality in patients with secondary peritonitis.
• To identify key clinical factors that correlate with morbidity and mortality in this patient group.

Main Methods:

• Prospective data collection from 224 secondary peritonitis patients over 10 years.
• Measurement of arterial lactate on admission (AL_I) and 24 hours post-surgery (AL₂₄), calculating lactate clearance.
• Correlation analysis of lactate indices, vasopressor use, mechanical ventilation, and demographic factors with mortality.

Main Results:

• Overall mortality was 16.07%; pulmonary complications were most common morbidity.
• Elevated preoperative (AL_I > 2.35 mmol/L) and postoperative (AL₂₄ > 2.05 mmol/L) lactate levels independently predicted morbidity and mortality.
• A prognostic scale using AL_I, AL₂₄, vasopressors, and mechanical ventilation demonstrated high sensitivity (97.22%) for mortality prediction.

Conclusions:

• Preoperative and postoperative arterial lactate levels are independent predictors of mortality in secondary peritonitis.
• Need for vasopressors and mechanical ventilation also significantly correlate with adverse outcomes.
• These parameters enable identification of high-risk patients for targeted, early goal-directed therapy to decrease mortality.