Lactate Clearance as a Prognostic Factor of Organ Failure in Sepsis

Lee,  Sun Beom; Hong,  Yun Sik; Kim,  Jung Youn; Kim,  Do Hyun; Moon,  Sung Woo; Choi,  Sung Hyuk; Lee,  Sung Woo

J Korean Soc Emerg Med > Volume 20(6); 2009 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2009;20(6): 642-648.

Lactate Clearance as a Prognostic Factor of Organ Failure in Sepsis

Sun Beom Lee, Yun Sik Hong, Jung Youn Kim, Do Hyun Kim, Sung Woo Moon, Sung Hyuk Choi, Sung Woo Lee

Emergency Department, College of Medicine, Korea University, Seoul, Korea. yshong@korea.ac.kr

ABSTRACT

PURPOSE:
To understand the prognostic value of initial lactate level and initial lactate clearance rate in severe sepsis and septic shock patients. We analyzed the Sequential Organ Failure Assessment (SOFA) score to determine the relationship with organ failure.
METHODS:
This was a prospective observational study on severe sepsis and septic patients. We calculated the SOFA score on admission (0), and at 4, 24, 48, and 72 hours. We divided the patients into four groups by lactate level of 4 mmol/L and initial lactate clearance rate of 10%. We compared the 28-day mortality rate and the SOFA score.
RESULTS:
Initial lactate level and initial lactate clearance rate on admission showed significant difference in the SOFA score, 28-day survival rate and survival curves (p<0.05). The initial serum lactate level according to the SOFA score of the renal system showed no significant difference at any time period. However, the lactate clearance rate was correlated with the renal system at 24, 48, and 72 hours. In addition, the group with high initial lactate level and low lactate clearance rate showed a significantly low 28-day survival rate (p<0.05) and the SOFA score was also high.
CONCLUSION:
We confirmed that the initial lactate level and the initial lactate clearance rate were closely related with the prognosis and SOFA score of severe sepsis and septic shock patients. According to each organ, the renal system was not significantly correlated with the initial lactate level but did show a significant relationship with the initial lactate clearance rate.

Key words: Lactic acid, Sepsis, Septic shock, Outcome assessment