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. 2020 Dec 18;10(12):1105.
doi: 10.3390/diagnostics10121105.

Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients

Raphael Romano Bruno  1 , Bernhard Wernly  2   3 , Stephan Binneboessel  1 , Philipp Baldia  1 , Dragos Andrei Duse  1 , Ralf Erkens  1 , Malte Kelm  1   4 , Behrooz Mamandipoor  5 , Venet Osmani  5 , Christian Jung  1
Affiliations

Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients

Raphael Romano Bruno et al. Diagnostics (Basel). .

Abstract

Purpose: Early lactate clearance is an important parameter for prognosis assessment and therapy control in sepsis. Patients with a lactate clearance >0% might differ from patients with an inferior clearance in terms of intensive care management and outcomes. This study analyzes a large collective with regards to baseline risk distribution and outcomes.

Methods: In total, 3299 patients were included in this analysis, consisting of 1528 (46%) ≤0% and 1771 (54%) >0% patients. The primary endpoint was intensive care unit (ICU) mortality. Multilevel logistic regression analyses were used to compare both groups: A baseline model (model 1) with lactate clearance as a fixed effect and ICU as a random effect was installed. For model 2, patient characteristics (model 2) were included. For model 3, intensive care treatment (mechanical ventilation and vasopressors) was added to the model. Models 1 and 2 were used to evaluate the primary and secondary outcomes, respectively. Model 3 was only used to evaluate the primary outcomes. Adjusted odds ratios (aORs) with respective 95% confidence intervals (CI) were calculated.

Results: The cohorts had no relevant differences regarding the gender, BMI, age, heart rate, body temperature, and baseline lactate. Neither the primary infection focuses nor the ethnic background differed between both groups. In both groups, the most common infection sites were of pulmonary origin, the urinary tract, and the gastrointestinal tract. Patients with lactate clearance >0% evidenced lower sepsis-related organ failure assessment (SOFA) scores (7 ± 6 versus 9 ± 6; p < 0.001) and creatinine (1.53 ± 1.49 versus 1.80 ± 1.67; p < 0.001). The ICU mortality differed significantly (14% versus 32%), and remained this way after multivariable adjustment for patient characteristics and intensive care treatment (aOR 0.43 95% CI 0.36-0.53; p < 0.001). In the additional sensitivity analysis, the lack of lactate clearance was associated with a worse prognosis in each subgroup.

Conclusion: In this large collective of septic patients, the 6 h lactate clearance is an independent method for outcome prediction.

Keywords: critically ill; intensive care; lactate; microcirculation; sepsis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Percentage of patients with a fluid intake greater than 30 mL/kg/h in the first 24 h for patients with a 6-h lactate clearance ≤0%versus >0% in [%].
Figure 2
Figure 2
ICU mortality for patients with a 6-h lactate clearance ≤0%versus > 0% in [%].
Figure 3
Figure 3
Forest plot of odds ratio (OR) patients with a 6-h lactate clearance ≤0%versus > 0 for different subgroups according to model 1. SOFA—sepsis-related organ failure assessment.
See this image and copyright information in PMC

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