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Risk factors for mortality in patients with low lactate level and septic shock

Authors
 Dong Hyun Oh  ;  Moo Hyun Kim  ;  Woo Yong Jeong  ;  Yong Chan Kim  ;  Eun Jin Kim  ;  Je Eun Song  ;  In Young Jung  ;  Su Jin Jeong  ;  Nam Su Ku  ;  Jun Yong Choi  ;  Young Goo Song  ;  June Myung Kim 
Citation
 Journal of Microbiology, Immunology and Infection, , 2017 
Journal Title
 Journal of Microbiology, Immunology and Infection 
ISSN
 1684-1182 
Issue Date
2017
Keywords
APACHEⅡ ; C-reactive protein ; Chronic heart failure ; Lactate ; SOFA score ; Score ; Septic shock
Abstract
BACKGROUND: According to the new definition of septic shock, vasopressor therapy and hyperlactatemia are essential for diagnosis. However, there is controversy regarding the cutoff value for lactate, and prognostic factors in patients with septic shock and hypolactatemia. This study evaluated the prognostic significance of the cutoff value for lactate level in septic shock patients. METHODS: The retrospective observational cohort study enrolled 1043 patients aged ≥18 years who meet the revised definition of septic shock. Clinical outcomes of patients with hyperlactatemia were compared with hypolactatemia. RESULTS: Of the 1022 eligible patients, 369 had an arterial lactate level ≤2 mmol/L. More patients in the high lactate group had poor prognosis than in the low lactate group. A high Sequential Organ Failure Assessment score (SOFA) score group was significant (p < 0.001) in predicting lactate levels. On the subgroup analysis of risk factors affecting mortality in the low lactate group, high Acute Physiology And Chronic Health Evaluation Ⅱ (APACHEⅡ) score (p = 0.003), high C-reactive protein (p = 0.034), and chronic heart failure (p = 0.001) were independently associated with 28-day mortality. CONCLUSION: Arterial lactate is a very reliable diagnostic and prognostic predictor of septic shock. However, despite low arterial lactate, patients with a high APACHEⅡ score, high C-reactive protein levels, and chronic heart failure had a poorer prognosis.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161282
DOI
10.1016/j.jmii.2017.08.009
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
구남수(Ku, Nam Su)
김용찬(Kim, Yong Chan)
김은진(Kim, Eun Jin)
김준명(Kim, June Myung)
송영구(Song, Young Goo)
송제은(Song, Je Eun)
오동현(Oh, Dong Hyun)
정수진(Jeong, Su Jin)
정우용(Jeong, Wooyong)
정인영(Jung, In Young)
최준용(Choi, Jun Yong)
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