Study of Early Lactate Clearance as an Independent Predictor of Survival in Patients with Presumed Sepsis

Aim: Measurement of serial serum lactate levels in patients presenting with sepsis and correlating with 1. early lactate clearance with mortality. 2. Early lactate clearance vs. first (baseline) lactate level in mortality prediction. 3. Early lactate clearance vs. ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION II score in mortality prediction. 4. Early lactate clearance vs. non lactate clearance in mortality prediction.

Place and Duration of Study: Department of General Medicine, SMIMER, Surat, Gujarat between December 1st 2017 and November 25th 2019.

Methodology: 50 patients (36 male, 14 females; age more than 18 years) Patient with sepsis were selected from Medicine ICU by using ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION II score ≥ 12 points. Lactate levels at 0, 6, 12, 24 and 48 hours were measured by using ABG done by ABL 800 basic analyzer. ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION II score was calculated on admission. Lactate clearance was calculated (<10% OR >10%) and was correlated with mortality (< 7 days or > 7 days).

Results: Among 50 patients studied, 39 patients were in lactate clearance group and 11 patients were in lactate non-clearance group. In lactate clearance group 35 (89%) patients survived and 4 (11%) patients expired. In lactate non-clearance group 9 (81%) patients expired and 2 (19%) patients survived. On observing the lactate trend, Serial serum lactate levels were decreasing in survived patients while serial serum lactate levels were static or increasing in expired patients. There was no correlation between serum lactate at 0 hour and mortality in the study group (p value > 0.05). There was correlation between serum lactate at 6, 12, and 24 hours with mortality (p value <0.05). There was strong correlation between serum lactate clearance and mortality (p value < 0.01).

Conclusion: Study confirmed the prognostic value of serial serum lactate monitoring and its clearance for prediction of mortality. We concluded that early lactate clearance could be used as an independent predictor of survival in patients with presumed sepsis.