Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr;11(4):543-553.
doi: 10.21037/tau-22-225.

The predictive performance of the lactate clearance rate combined with the APACHE II score in the prediction of sepsis-associated acute kidney injury in 7 days

Yezhou Shen  1 , Jiaoyang Yu  1 , Fei Zhou  1 , Juzhen Yan  2 , Jing Yang  3 , Ying Guo  4   5 , Leqing Lin  1
Affiliations

The predictive performance of the lactate clearance rate combined with the APACHE II score in the prediction of sepsis-associated acute kidney injury in 7 days

Yezhou Shen et al. Transl Androl Urol. 2022 Apr.

Abstract

Background: The purpose of this study was to evaluate the accuracy of the lactate clearance rate (LCR) combined with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in the prediction of sepsis-associated acute kidney injury (SAKI).

Methods: Sepsis patients were divided into the SAKI group and non-SAKI group. Arterial blood lactate was collected at 0 h (before treatment), 2 h, 4 h, 6 h, and 8 h (after treatment), and the LCR was calculated. The physiological parameters and laboratory test results were used to calculate the APACHE II score and the Sequential Organ Failure Assessment (SOFA) score. The receiver operating characteristic (ROC) curves of LCR, APACHE II score and SOFA score for predicting patients with SAKI were drawn. Two single indicators with high areas under the curves (AUCs) were selected to calculate the joint probability through regression analysis, and the prediction efficiency corresponding to each curve was analyzed.

Results: There were significant differences in LCR between different groups and time periods (Fgroup=17.44, Pgroup ≤0.0001, Ftime =11.71, Ptime =0.0014). After 8 h of treatment, there was a significant difference in the overall compliance rate between the 2 groups (P<0.0001). In addition, after 24 h of treatment, the APACHE II score in the SAKI group was significantly higher than that in the non-SAKI group (P=0.0007), and SOFA score was also significantly higher than that in the non-SAKI group (P=0.0001). ROC curve showed that the 0-8 h LCR and APACHE II scores had a high predictive performance for the acute kidney injury (AKI) occurrence in sepsis patients, and AUCs were 0.7637 and 0.7517, respectively, while the combined AUC of the 2 indicators was 0.7975.

Conclusions: The 0-8 h LCR combined with APACHE II score can improve the early predictive value of SAKI, reduce the risk of AKI in patients with sepsis/septic shock, and reduce the social and family burden, which is worthy of clinical application.

Keywords: Acute Physiology and Chronic Health Evaluation II (APACHE II) score; Lactate clearance rate (LCR); sepsis-associated acute kidney injury (SAKI).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-22-225/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Comparison of LCR, APACHE II score, and SOFA score between the 2 groups. (A) The LCR of the 2 groups of patients at 0-2h, 0-4h, 0-6h, and 0-8 h after treatment. (B) The lactate clearance of the 2 groups of patients at 8 h after treatment. (C) The APACHE II scores of the 2 groups of patients after 24 h of treatment. (D) The SOFA scores of the 2 groups of patients immediately after admission and 24 h after treatment. LCR, lactate clearance rate; SAKI, sepsis-associated acute kidney injury; APACHE II, Acute Physiology and Chronic Health Evaluation II; SOFA, Sequential Organ Failure Assessment.
Figure 2
Figure 2
ROC curves. (A) 0–6 h LCR; (B) 0–8 h LCR; (C) APACHE II score; (D) SOFA score (24 h); (E) 0–8 h LCR combined with SOFA score (24 h). The diagonals in the figure are reference lines. ROC, receiver operating characteristic; LCR, lactate clearance rate; APACHE II, Acute Physiology and Chronic Health Evaluation II; SOFA, Sequential Organ Failure Assessment.
Figure 3
Figure 3
Comparison of blood LC levels and LCR in patients with different prognoses. (A) Blood LC levels of patients with different prognoses at 0 h, 2 h, 4 h, 6 h, and 8 h; (B) LCR of patients with different prognoses at 0–2 h, 0–4 h, 0–6 h, and 0–8 h. LC, lactic acid; LCR, lactate clearance rate.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Peerapornratana S, Manrique-Caballero CL, Gómez H, et al. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int 2019;96:1083-99. 10.1016/j.kint.2019.05.026 - DOI - PMC - PubMed
    1. Klenzak J, Himmelfarb J. Sepsis and the kidney. Crit Care Clin 2005;21:211-22. 10.1016/j.ccc.2005.01.002 - DOI - PubMed
    1. Nolt B, Tu F, Wang X, et al. Lactate and Immunosuppression in Sepsis. Shock 2018;49:120-5. 10.1097/SHK.0000000000000958 - DOI - PMC - PubMed
    1. Goyal P, Agarwal R, Srivastava H, et al. Serial Serum Lactic Acid in Pregnancy-Associated Sepsis for Maternal Outcome. J Obstet Gynaecol India 2020;70:342-8. 10.1007/s13224-020-01348-y - DOI - PMC - PubMed
    1. Pan J, Peng M, Liao C, et al. Relative efficacy and safety of early lactate clearance-guided therapy resuscitation in patients with sepsis: A meta-analysis. Medicine (Baltimore) 2019;98:e14453. 10.1097/MD.0000000000014453 - DOI - PMC - PubMed