1887
Volume 2022, Issue 5
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Lactic acid is a metabolite that is physiologically produced and metabolized in a balanced state in the body from glucose. Critically ill patients with sepsis are found to have higher serum lactate levels. In this study, the established Intensive Care Unit (ICU) scores that are Sequential Organ Failure Assessment (SOFA) and Acute physiology and chronic health evaluation (APACHE IV) were compared to serial serum lactate measurements as a superior predictor of mortality in critically ill patients with sepsis admitted under Intensive Care Unit. In this cross-sectional study, 280 patients who were admitted to ICU care and were diagnosed to have sepsis were enrolled from August 2019 to September 2021. The presentation of the categorical variables was done in the form of numbers and percentages (%). On the other hand, the quantitative data were presented as the means ± SD and as median with 25th and 75th percentiles (interquartile range). The data normality was checked by using the Kolmogorov-Smirnov test. In the cases in which the data was not normal, nonparametric tests were used. An ICU mortality rate of 43.21% was observed among the 280 adult patients diagnosed with sepsis admitted to ICU involved in this study. The interpretation of the area under the Receiver operating curve (ROC) showed that the performance of serum Lactate (mmol/L) on day 3 (Area under the curve [AUC] 0.909; 95% CI: 0.867 to 0.941) was very much comparable to APACHE IV score on day 3(AUC 0.931; 95% CI: 0.893 to 0.960). Serum lactate on day 3 was even better than the SOFA score on day 3(AUC 0.936; 95% CI: 0.898 to 0.963). Among all the parameters, the APACHE IV score on day 3 was the best predictor of mortality at the cut-off point of >132 with a 91.0% chance of correctly predicting mortality. When compared with SOFA and APACHE IV scores, serial serum lactate was reliable and comparable as far as an outcome in terms of mortality is concerned in patients with sepsis admitted to the intensive care unit. Thus, serum lactate can be considered a surrogate marker for predicting mortality in sepsis patients in low-resource rural setups.

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2022-06-30
2024-02-26
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References

  1. Montagnani A, Nardi R. Lactic acidosis, hyperlactatemia, and sepsis. Italian J Med2016:10:(4):282–8.
    [Google Scholar]
  2. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014 Apr 2;311:(13):1308–16.
    [Google Scholar]
  3. Krishna U, Joshi SP, Modh M. An evaluation of serial blood lactate measurement as an early predictor of shock and its outcome in patients of trauma or sepsis. Indian J Crit Care Med. 2009 Apr-Jun;13:(2):66–73.
    [Google Scholar]
  4. Dafal A, Kumar S, Agrawal S, Acharya S, Nirmal A. Admission Anion Gap Metabolic Acidosis and Its Impact on Patients in Medical Intensive Care Unit. J Lab Physicians. 2021 Jun;13:(2):107–111.
    [Google Scholar]
  5. Dubey A, Kumar S, Acharya S, Wanjari A, Bawankule S, Agrawal S, et al. Impact of Red Cell and Platelet Distribution Width in Patients of Medical Intensive Care Unit. J Lab Physicians. 2021 Jun 26;13:(4):309–316.
    [Google Scholar]
  6. Kumar S, Gattani SC, Baheti AH, Dubey A. Comparison of the Performance of APACHE II, SOFA, and mNUTRIC Scoring Systems in Critically Ill Patients: A 2-year Cross-sectional Study. Indian J Crit Care Med. 2020 Nov;24:(11):1057–1061.
    [Google Scholar]
  7. Levy M, Fink M, Marshall J et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Medicine. 2003;29:(4):530–538.
    [Google Scholar]
  8. Asati AK, Gupta R, Behera D. To determine blood lactate levels in patients with sepsis admitted to a respiratory intensive care unit and to correlate with their hospital outcomes. Int J Crit Care Emerg Med.. 2018;4:045.
    [Google Scholar]
  9. Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009 May;37:(5):1649–54.
    [Google Scholar]
  10. Dabhi AS, Khedekar SS, Mehalingam V. A Prospective Study of Comparison of APACHE-IV & SAPS-II Scoring Systems and Calculation of Standardised Mortality Rate in Severe Sepsis and Septic Shock Patients. J Clin Diagn Res. 2014 Oct;8:(10):MC09-13.
    [Google Scholar]
  11. Basile-Filho A, Lago AF, Menegueti MG, Nicolini EA, Rodrigues LAB, Nunes RS, et al. The use of APACHE II, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients: A retrospective cohort study. Medicine (Baltimore). 2019 Jun;98:(26):e16204.
    [Google Scholar]
  12. Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, et al; LACTATE study group. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010 Sep 15;182:(6):752–61.
    [Google Scholar]
  13. Arnold RC, Shapiro NI, Jones AE, Schorr C, Pope J, Casner E, et al; Emergency Medicine Shock Research Network (EMShockNet) Investigators. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock. 2009 Jul;32:(1):35–9.
    [Google Scholar]
  14. Nichol A, Bailey M, Egi M, Pettila V, French C, Stachowski E, et al. Dynamic lactate indices as predictors of outcome in critically ill patients. Crit Care. 2011;15:(5):R242.
    [Google Scholar]
  15. Wong HR, Lindsell CJ, Pettilä V, Meyer NJ, Thair SA, Karlsson S, et al. A multibiomarker-based outcome risk stratification model for adult septic shock. Crit Care Med.2014;42:(4):781–9.
    [Google Scholar]
  16. Hernández G, Cavalcanti AB, Ospina-Tascón G, et al; ANDROMEDA-SHOCK Study Investigators. Early goal-directed therapy using a physiological holistic view: the ANDROMEDA-SHOCK—a randomized controlled trial. Ann Intensive Care. 2018;8:(1):52.doi:10.1186/s13613-018-0398-2
    [Google Scholar]
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