Normal-range blood lactate concentration in septic shock is prognostic and predictive

Shock
Petch WacharasintKeith R Walley

Abstract

We hypothesized that lactate levels even within the normal range are prognostic and that low lactate levels predict a beneficial response to vasopressin infusion in septic shock. We conducted a retrospective analysis using the Vasopressin in Septic Shock Trial (VASST) as a derivation cohort (n = 665), then validated using another single-center septic shock cohort, St Paul's Hospital (SPH) cohort (n = 469). Lactate levels were divided into quartiles. The primary outcome variable was 28-day mortality in both cohorts. We used receiver operating characteristic (ROC) curve analysis to compare the prognostic value of lactate concentrations versus Acute Physiology and Chronic Health Evaluation II scores. We then explored whether lactate concentrations might predict beneficial response to vasopressin compared with noradrenaline in VASST. Normal lactate range is less than 2.3 mmol/L. At enrollment, patients in the second quartile (1.4 < lactate < 2.3 mmol/L) had significantly increased mortality and organ dysfunction compared with patients who had lactate ≤ 1.4 mmol/L (quartile 1) (P < 0.0001). Quartile 2 outcomes were as severe as quartile 3 (2.3 ≤ lactate < 4.4 mmol/L) outcomes. Baseline lactate values (ar ea under the ROC curve = 0.6...Continue Reading

References

Oct 1, 1985·Critical Care Medicine·W A KnausJ E Zimmerman
Aug 1, 1995·Journal of Applied Physiology·M J HerbertsonK R Walley
Mar 14, 2001·Critical Care Medicine·B A Mizock
Jan 17, 2002·The New England Journal of Medicine·E RiversUNKNOWN Early Goal-Directed Therapy Collaborative Group
Mar 20, 2002·Burns : Journal of the International Society for Burn Injuries·James C JengMarion H Jordan
Sep 17, 2003·Critical Care : the Official Journal of the Critical Care Forum·Ryon M BatemanChristopher G Ellis
Mar 18, 2004·Critical Care : the Official Journal of the Critical Care Forum·André MeregalliGilberto Friedman
Aug 3, 2004·Critical Care Medicine·H Bryant NguyenMichael C Tomlanovich
Oct 8, 2004·Critical Care : the Official Journal of the Critical Care Forum·Fabienne TamionGuy Bonmarchand
Jan 12, 2005·Archives of Internal Medicine·Ainsley M SutherlandJames A Russell
Apr 28, 2005·Annals of Emergency Medicine·Nathan I ShapiroJ Woodrow Weiss
Jul 1, 2006·Current Opinion in Critical Care·Bruno Levy
May 19, 2007·Shock·Izuru WatanabeJun Takezawa
Dec 26, 2007·Critical Care Medicine·R Phillip DellingerUNKNOWN World Federation of Societies of Intensive and Critical Care Medicine
Feb 29, 2008·The New England Journal of Medicine·James A RussellUNKNOWN VASST Investigators
Mar 28, 2009·Critical Care Medicine·Mark E MikkelsenJason D Christie
Feb 25, 2010·JAMA : the Journal of the American Medical Association·Alan E JonesUNKNOWN Emergency Medicine Shock Research Network (EMShockNet) Investigators
Feb 26, 2010·Critical Care : the Official Journal of the Critical Care Forum·Alistair D NicholDavid James Cooper
May 14, 2010·American Journal of Respiratory and Critical Care Medicine·Tim C JansenUNKNOWN LACTATE study group
Mar 29, 2011·Critical Care Clinics·Okorie Nduka Okorie, Phil Dellinger
Oct 22, 2011·Critical Care : the Official Journal of the Critical Care Forum·Alistair NicholRinaldo Bellomo

❮ Previous
Next ❯

Citations

Mar 16, 2013·Biomedical Microdevices·Christian N Kotanen, Anthony Guiseppi-Elie
Feb 16, 2013·Current Opinion in Pulmonary Medicine·Mervyn Singer
Dec 19, 2012·Shock·Rafael Simone SaiaEvelin Capellari Cárnio
Oct 4, 2013·Shock·Ravi S SamrajHector R Wong
Dec 18, 2013·Critical Care Medicine·Hector R WongKeith R Walley
Sep 6, 2013·Annals of the American Thoracic Society·Vincent LiuGabriel J Escobar
Jul 1, 2014·Current Opinion in Critical Care·James J Douglas, Keith R Walley
May 20, 2014·Der Anaesthesist·I Gradwohl-MatisM Dünser
Jul 1, 2014·Shock·Afshin ParsikiaAmit R T Joshi
Dec 3, 2014·Emergency Medicine Clinics of North America·Joshua Keegan, Charles R Wira
Sep 2, 2015·Proceedings of the National Academy of Sciences of the United States of America·Tomohiro SuharaYoji Andrew Minamishima
Nov 15, 2014·Critical Care : the Official Journal of the Critical Care Forum·Mercedes Garcia-AlvarezRinaldo Bellomo
May 8, 2015·Intensive Care Medicine·D J P O'Callaghan, Anthony C Gordon
Sep 9, 2015·Current Opinion in Critical Care·Emanuel P RiversMargaret Disselkamp
Mar 14, 2013·Critical Reviews in Clinical Laboratory Sciences·James D Faix
Nov 14, 2014·Journal of Nippon Medical School = Nippon Ika Daigaku Zasshi·Etsuko SatohHiroyuki Yokota
May 6, 2015·The American Journal of Emergency Medicine·Khrongwong MusikatavornDhanadol Rojanasarntikul
Jul 23, 2015·Evidence-based Complementary and Alternative Medicine : ECAM·Zijun MouXuezhong Yu
Apr 22, 2015·Shock·Frederick D'AragonUNKNOWN Canadian Critical Care Trials Group
Feb 25, 2015·Journal of Critical Care·Sharukh LokhandwalaMichael W Donnino
Jul 26, 2014·The American Journal of Emergency Medicine·Yun-Xia Chen, Chun-Sheng Li
Dec 4, 2014·Journal of Critical Care·Daniel O Thomas-RueddelUNKNOWN Medical Education for Sepsis Source Control and Antibiotics Study Group
Apr 3, 2014·Infection & chemotherapy·Sung-Yeon Cho, Jung-Hyun Choi
Nov 1, 2013·Critical Care : the Official Journal of the Critical Care Forum·Magnus F KaffarnikMartin Stockmann
Jul 2, 2016·Critical Care : the Official Journal of the Critical Care Forum·H Bryant NguyenEmanuel P Rivers
Nov 5, 2016·Journal of Critical Care·Michael J WardJesse M Pines
Mar 24, 2016·Journal of Burn Care & Research : Official Publication of the American Burn Association·Athina LavrentievaMilitsa Bitzani
Apr 19, 2018·Biochemia Medica·Ionas Papassotiriou, Artemissia-Phoebe Nifli
Jan 18, 2019·Critical Care Medicine·Ashish K Khanna
Jan 18, 2019·Critical Care Medicine·Patrick J GleesonJacques Creteur
Apr 3, 2019·Acta Anaesthesiologica Scandinavica·Panuwat PromsinOlav Rooyackers
Jun 11, 2019·Journal of Intensive Care Medicine·Ralphe Bou CheblYaseen M Arabi
Jul 6, 2019·Acta Anaesthesiologica Scandinavica·Tine Sylvest MeyhoffAnders Perner
Aug 28, 2019·International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group·Anna CorderfeldtRoger Olofsson Bagge

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