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Article

Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients

1
Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
2
Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
3
Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, 171 64 Stockholm, Sweden
4
Cardiovascular Research Institute Düsseldorf (CARID), 40225 Düsseldorf, Germany
5
Fondazione Bruno Kessler Research Institute, 38123 Trento, Italy
*
Author to whom correspondence should be addressed.
Both authors contributed equally.
Diagnostics 2020, 10(12), 1105; https://doi.org/10.3390/diagnostics10121105
Received: 11 November 2020 / Revised: 14 December 2020 / Accepted: 16 December 2020 / Published: 18 December 2020
Purpose: Early lactate clearance is an important parameter for prognosis assessment and therapy control in sepsis. Patients with a lactate clearance >0% might differ from patients with an inferior clearance in terms of intensive care management and outcomes. This study analyzes a large collective with regards to baseline risk distribution and outcomes. Methods: In total, 3299 patients were included in this analysis, consisting of 1528 (46%) ≤0% and 1771 (54%) >0% patients. The primary endpoint was intensive care unit (ICU) mortality. Multilevel logistic regression analyses were used to compare both groups: A baseline model (model 1) with lactate clearance as a fixed effect and ICU as a random effect was installed. For model 2, patient characteristics (model 2) were included. For model 3, intensive care treatment (mechanical ventilation and vasopressors) was added to the model. Models 1 and 2 were used to evaluate the primary and secondary outcomes, respectively. Model 3 was only used to evaluate the primary outcomes. Adjusted odds ratios (aORs) with respective 95% confidence intervals (CI) were calculated. Results: The cohorts had no relevant differences regarding the gender, BMI, age, heart rate, body temperature, and baseline lactate. Neither the primary infection focuses nor the ethnic background differed between both groups. In both groups, the most common infection sites were of pulmonary origin, the urinary tract, and the gastrointestinal tract. Patients with lactate clearance >0% evidenced lower sepsis-related organ failure assessment (SOFA) scores (7 ± 6 versus 9 ± 6; p < 0.001) and creatinine (1.53 ± 1.49 versus 1.80 ± 1.67; p < 0.001). The ICU mortality differed significantly (14% versus 32%), and remained this way after multivariable adjustment for patient characteristics and intensive care treatment (aOR 0.43 95% CI 0.36–0.53; p < 0.001). In the additional sensitivity analysis, the lack of lactate clearance was associated with a worse prognosis in each subgroup. Conclusion: In this large collective of septic patients, the 6 h lactate clearance is an independent method for outcome prediction. View Full-Text
Keywords: sepsis; intensive care; critically ill; lactate; microcirculation sepsis; intensive care; critically ill; lactate; microcirculation
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MDPI and ACS Style

Bruno, R.R.; Wernly, B.; Binneboessel, S.; Baldia, P.; Duse, D.A.; Erkens, R.; Kelm, M.; Mamandipoor, B.; Osmani, V.; Jung, C. Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients. Diagnostics 2020, 10, 1105. https://doi.org/10.3390/diagnostics10121105

AMA Style

Bruno RR, Wernly B, Binneboessel S, Baldia P, Duse DA, Erkens R, Kelm M, Mamandipoor B, Osmani V, Jung C. Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients. Diagnostics. 2020; 10(12):1105. https://doi.org/10.3390/diagnostics10121105

Chicago/Turabian Style

Bruno, Raphael R., Bernhard Wernly, Stephan Binneboessel, Philipp Baldia, Dragos A. Duse, Ralf Erkens, Malte Kelm, Behrooz Mamandipoor, Venet Osmani, and Christian Jung. 2020. "Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients" Diagnostics 10, no. 12: 1105. https://doi.org/10.3390/diagnostics10121105

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