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Related Experiment Video

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Author Spotlight: Developing Innovative Therapeutic Strategies for Hemorrhagic Shock Research

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Nutritional status-based model for predicting low-lactate shock: A retrospective cohort study.

Xiaofang Xu^1,2, Fang Hu³, Zhaocai Zhang^1,4,5

¹Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China.

Shock (Augusta, Ga.)

|September 23, 2025

Summary

Low-lactate shock, a condition missed by current sepsis definitions, has a significant mortality risk. A new predictive model, NRS-APACHE II-TG-TBIL, aids in its early detection.

Keywords:

Lactate mortality nutritional risk screening 2002 prognostic risk model shock

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Area of Science:

Critical Care Medicine
Emergency Medicine
Internal Medicine

Background:

Sepsis-3.0 criteria for septic shock (hypotension with lactate >2.0 mmol/L) may overlook low-lactate shock.
Low-lactate shock, characterized by hypotension without elevated lactate, is a clinically significant phenotype with unclear epidemiology and prognosis.
This highlights a gap in current shock management and diagnostic models.

Purpose of the Study:

To determine the prevalence of low-lactate shock.
To identify risk factors associated with low-lactate shock.
To validate a predictive model for low-lactate shock.

Main Methods:

Retrospective cohort study of 3,134 shock patients (Jan 2015-Mar 2022).
Propensity score matching (1:2 ratio) to control for confounders.
Multivariable logistic regression and ROC analysis to identify predictors and validate the NRS-APACHE II-TG-TBIL model.

Main Results:

Low-lactate shock prevalence was determined, with a 28-day mortality rate of 25.4%.
Independent predictors for low-lactate shock included Nutritional Risk Screening (NRS-2002), APACHE II score, triglycerides (TG), and total bilirubin (TBIL).
The NRS-APACHE II-TG-TBIL model demonstrated excellent discrimination (AUC=0.800) with balanced sensitivity (72.6%) and specificity (73.5%).

Conclusions:

Low-lactate shock presents a substantial mortality risk, underscoring the need for improved diagnostic strategies.
The validated NRS-APACHE II-TG-TBIL model offers an effective tool for early detection of low-lactate shock.
This model addresses critical diagnostic gaps in managing patients with shock.