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- Title
Serum lactate as a predictor of mortality in patients with infection.
- Authors
Trzeciak, Stephen; Dellinger, R. Phillip; Chansky, Michael E.; Arnold, Ryan C.; Schorr, Christa; Milcarek, Barry; Hollenberg, Steven M.; Parrillo, Joseph E.
- Abstract
<bold>Objective: </bold>To determine the utility of an initial serum lactate measurement for identifying high risk of death in patients with infection.<bold>Design and Setting: </bold>Post-hoc analysis of a prospectively compiled registry in an urban academic hospital.<bold>Participants: </bold>Patients with (a) a primary or secondary diagnosis of infection and (b) lactate measurement who were admitted over the 18 months following hospital-wide implementation of the Surviving Sepsis Campaign guideline for lactate measurement in patients with infection and possible severe sepsis. There were 1,177 unique patients, with an in-hospital mortality of 19%.<bold>Measurements and Results: </bold>Outcome measures included acute-phase (<or=3 days) death and in-hospital death. We defined lactate ranges a priori (low, 0.0-2.0; intermediate, 2.1-3.9; high, 4.0 mmol/l or above)--and tested for linear associations with mortality by one-way analysis of variance. We determined sensitivity/specificity, odds ratios, and likelihood ratios for a lactate >or=4.0 mmol/l and performed a Bayesian analysis to determine its impact on a full range (0.01-0.99) of hypothetical pretest probability estimates for death. In-hospital mortality was 15%, 25%, and 38% in low, intermediate, and high lactate groups, respectively. Acute-phase deaths and in-hospital deaths increased linearly with lactate. An initial lactate >or=4.0 mmol/l was associated with sixfold higher odds of acute-phase death; however, a lactate level less than 4 mmol/l had little impact on probability of death.<bold>Conclusions: </bold>When broadly implemented in routine practice, measurement of lactate in patients with infection and possible sepsis can affect assessment of mortality risk. Specifically, an initial lactate >or=4.0 mmol/l substantially increases the probability of acute-phase death.
- Subjects
NEW Jersey; PROGNOSIS; SERUM; HEALTH outcome assessment; MORTALITY; PATIENTS; SEPSIS; ACADEMIC medical centers; COMPARATIVE studies; LACTIC acid; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; PROBABILITY theory; RESEARCH; EVALUATION research; ACQUISITION of data; SEVERITY of illness index
- Publication
Intensive Care Medicine, 2007, Vol 33, Issue 6, p970
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-007-0563-9