Influence of Lactate on Prognostic Value of Patients with Septic Shock

DOI: https://doi.org/10.62517/jmhs.202405103

Author(s)

Yue Yan1#, Yu Han2#, Dingguo Li1,*, Xiangkui Li3, Hao Zhu1,*, Luyao Zhou1, Jing Liu1, Jing Zhang1, Yinxu Liu1, Hao Wang1

Affiliation(s)

1College of Physics and Information Engineering, Zhaotong University, Zhaotong, Yunan, China 2Rolling car room, Hongta Tobacco (Group) Co., Ltd. Dali Cigarette Factory, Dali, Yunnan, China 3College of Computer Science and Technology, Harbin University of Science and Technology, Harbin, Heilongjiang, China # These authors contributed equally to the research. *Corresponding Authors

Abstract

The latest time for lactate measurement in patients with septic shock in the intensive care unit (ICU) is still controversial, and there is little mention of the significant impact of lactate levels on patient mortality. This study aims to use statistical methods to analyze and predict the prognosis of patients with septic shock using lactate measurement values. All data comes from the eICU collaborative research database. This study first used statistical methods to describe the baseline characteristics of patients. Then, the optimal judgment threshold for lactate measurement was determined using the Jordan index, and patients were divided into two groups based on the optimal threshold. Based on this, survival analysis was conducted using the Kaplan Meier curve and the binary values of lactate levels, while conducting a multivariate analysis. Finally, the relationship between the latest measurement time of lactate and outcome was found through smooth curve fitting. The main exposed factor is lactate measurement, and the main outcome is 28 days mortality. The study included 5776 eligible patients with septic shock, including 4920 surviving patients and 856 deceased patients. Observations have confirmed that patients with severe sepsis or septic shock whose lactate value exceeds 2.29 mmol/L after entering the ICU have an increased risk of death. At the same time, the latest lactate measurement time after entering the ICU is 0.42 days, which is about 10 hours before entering the ICU ward; otherwise, it will endanger the patient's life.

Keywords

Septic Shock; Lactate; Prognosis; Mortality Rate; eICU Collaborative Research Database

References

[1] Ji, M.L., Peng, Y.G., Yang, B.C., Yang, Y.S., Gu, L., Yan, X.L., Xu, T. The impact of age on the prognostic value of lactate clearance rate in predicting septic shock patients. International Journal of Anesthesiology and Resuscitation, 2020, 41 (4). [2] Ma, G., Lu, Z. Metabolism and significance of lactate in sepsis patients. Journal of Wenzhou Medical College, 2022, 44 (12): 4. [3] Bai, H.Y. The relationship between serum lactate levels and sepsis mortality, septic shock, and organ failure. Chinese Journal of Critical Care Medicine, 2009, 21 (05): 273-273. [4] Yang, M.C., Hu, S. In vivo lactate clearance rate as a warning for survival in sepsis patients. Chinese Journal of Critical Care Medicine, 2009, 21 (10): 1. [5] Li, Z.H., Chen, Y.P., Qin, H.C. Application of lactate and lactate clearance rate in the diagnosis and prognosis evaluation of sepsis. Serpentine, 2021, 33 (2): 4. [6] Howell, M.D., Donnino, M., Clardy, P., Talmor, D., Shapiro, N.I.. Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med 2007; 33 11:1892-1899. [7] Mikkelsen, M.E., Miltiades, A.N., Gaieski, D.F., Goyal, M., Fuchs, B.D., Shah, C.V., Bellamy, S.L., Christie, J.D.. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med 2009; 37 5:1670-1677. [8] Wacharasint, P., Nakada, T.A., Boyd, J.H., Russell, J.A., Walley, K.R.. Normal-range blood lactate concentration in septic shock is prognostic and predictive. Shock 2012; 38 1:4-10. [9] Nichol, A.D., Egi, M., Pettila, V., Bellomo, R., French, C., Hart, G., Davies, A., Stachowski, E., Reade, M.C., Bailey, M.. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care 2010; 14 1:R25. [10] Dellinger, R.P., Levy, M.M., Rhodes, A., Annane, D., Gerlach, H., Opal, S.M,, Sevransky, J.E., Sprung, C.L., Douglas, I.S., Jaeschke, R.. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med.2013; 412: 580-637. [11] Kang, Y.R., Um, S.W., Koh, W.J., Suh, G.Y., Chung, M.P., Kim, H., Kwon, O.J., Jeon, K.. Initial lactate level and mortality in septic shock patients with hepatic dysfunction. Anaesth Intensive Care 2022; 39 5:862-867