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Título : Lactate quartile concentration and prognosis in severe sepsis and septic shock.
Autor : Torre-Prados, M de la
García-de la Torre, A
Trujillano-Fernández, C
Pérez-Vacas, J
Puerto-Morlán, A
Cámara-Sola, E
García-Alcántara, A
Filiación: [Torre-Prados,M de la; Trujillano-Fernández,C; Pérez-Vacas,J; Puerto-Morlán,A; Cámara-Sola,E; García-Alcántara,A] Hospital Virgen de la Victoria, Málaga, Spain. [García-de la Torre,A] Puerto Real University Hospital, Cádiz, Spain.
Palabras clave : Marcadores biológicos
Ácido láctico
Valor predictivo de las pruebas
Choque séptico
MeSH: Medical Subject Headings::Chemicals and Drugs::Biological Factors::Biological Markers
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Carboxylic Acids::Hydroxy Acids::Lactates::Lactic Acid
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Epidemiologic Research Design::Sensitivity and Specificity::Predictive Value of Tests
Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Infection::Sepsis::Shock, Septic
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Fecha de publicación : Mar-2014
Editorial : BioMed Central
Cita Bibliográfica: Torre-Prados M de la, García-de la Torre A., Trujillano-Fernández C., Pérez-Vacas J., Puerto-Morlán A., Cámara-Sola E. et al. Lactate quartile concentration and prognosis in severe sepsis and septic shock. Critical Care. 2014;18(Suppl. 1):S62-S63
Abstract: Introduct ion The Surviving Sepsis Campaign (SSC) indicates that a lactate (LT) concentration greater than 4ımmol/l indicates early resuscitation bundles. However, several recent studies have suggested that LT values lower than 4ımmol/l may be a prognostic marker of adverse outcome. The aim of this study was to identify clinical and analytical prognostic parameters in severe sepsis (SS) or septic shock (ShS) according to quartiles of blood LT concentration. Methods A cohort study was designed in a polyvalent ICU. We studied demographic, clinical and analytical parameters in 148 critically ill adults, within 24ıhours from SS or ShS onset according to SSC criteria. We tested for diı erences in baseline characteristics by lactate interval using a KruskalıWallis test for continuous data or a chi-square test for categorical data and reported the median and interquartile ranges; SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Results We analyzed 148 consecutive episodes of SS (16%) or ShS (84%). The median age was 64 (interquartile range, 48.7 to 71)ıyears; male: 60%. The main sources of infection were respiratory tract 38% and intra-abdomen 45%; 70.7% had medical pathology. Mortality at 28ıdays was 22.7%. Quartiles of blood LT concentration were quartile 1 (Q1): 1.87ımmol/l or less, quartile 2 (Q2): 1.88 to 2.69ımmol/l, quartile 3 (Q3): 2.7 to 4.06ımmol/l, and quartile 4 (Q4): 4.07ımmol/l or greater (Tableı1). The median LT concentrations of each quartile were 1.43 (Q1), 2.2 (Q2), 3.34 (Q3), and 5.1 (Q4) mmol/l (Pı<0.001). The diı erences between these quartiles were that the patients in Q1 had signiı cantly lower APACHE II scores (Pı=ı0.04), SOFA score (Pı=ı0.024), number of organ failures (NOF) (Pı<0.001) and ICU mortality (Pı=ı0.028), compared with patients in Q2, Q3 and Q4. Patients in Q1 had signiı cantly higher cholesterol (Pı=ı0.06) and lower procalcitonin (Pı=ı0.05) at enrolment. At the extremes, patients in Q1 had decreased 28-day mortality (Pı=ı0.023) and, patients in Q4 had increased 28-day mortality, compared with the other quartiles of patients (Pı=ı0.009). Interestingly, patients in Q2 had signiı cant increased mortality compared with patients in Q1 (Pı=ı0.043), whereas the patients in Q2 had no signiı cant diı erence in 28-day mortality compared with patients in Q3. Conclusion Adverse outcomes and several potential risk factors, including organ failure, are signiı cantly associated with higher quartiles of LT concentrations. It may be useful to revise the cutoı value of lactate according to the SSC (4 mmol/l).
Versión del editor :
DOI: 10.1186/cc13366
ISSN : 1364-8535 (Print)
1466-609X (Online)
Appears in Collections:01- Artículos - Hospital Virgen de la Victoria

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