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The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock
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Jung Hwan Ahn, Sang Cheon Choi, Young Gi Min, Yoon Seok Jung, Sung Hee Chung, Young Joo Lee
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Korean J Crit Care Med. 2009;24(3):134-139.
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DOI: https://doi.org/10.4266/kjccm.2009.24.3.134
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 Abstract
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- BACKGROUND
The lactate concentration should be used to examine the severity of sepsis or any state of shock. This study was conducted to investigate the prognostic power of the lactate clearance, as adjusted for time, between the survivors and nonsurvivors of patients with severe sepsis or septic shock.
METHODS
The study was performed on 67 patients over 16 years old and who were admitted to the intensive care unit (ICU) with severe sepsis or septic shock. They were divided into the survivors (n = 37) and nonsurvivors (n = 30). The blood lactate concentrations were assayed at intervals ranging from 8 to 24 hours and the APACHE III scoring was done daily for 2 weeks or until discharge or death. The lactate clearance, as adjusted for time, was defined using the following formula: [(the maximal lactate concentration - the normal lactate concentration)/the time to normalize the lactate concentration] x 1,000.
RESULTS
There were no significant differences of age, gender and the length of the ICU stay between the survivors and non-survivors. There were significant difference of the time to measuring the maximal serum lactate concentration (3.2 +/- 12.3 hours vs. 28.8 +/- 64.6 hours, respectively; p = 0.037), the lactate clearance, as adjusted for time (132.27 +/- 112.88 mol/L . hour vs. 59.67 +/- 72.60 mol/L .
hour, respectively; p = 0.002), the lactate clearance during 24 hours (46.0 +/- 26.3% vs. 22.6 +/- 45.6%, respectively; p = 0.018) and the APACHE III score (67.6 +/- 22.7 vs. 83.9 +/- 21.6, respectively; p = 0.005) between the survivors and non-survivors. The lactate clearance, as adjusted for time and the APACHE III score were the predictive factors for survival on the logistic regression analysis (odd ratio 0.987; p = 0.028 vs. odd ratio 1.046; p = 0.006).
CONCLUSIONS
Lactate clearance, as adjusted for time, could be used as a prognostic index, as well as the APACHE III score, for patients with severe sepsis or septic shock.
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Citations
Citations to this article as recorded by  - Lactate Clearance and Outcome in Septic Shock Patients with Low Level of Initial Lactate
Yun Su Sim, Cho Rom Hahm, So Yeon Lim, Gee Young Suh, Kyeongman Jeon
The Korean Journal of Critical Care Medicine.2011; 26(2): 78. CrossRef
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A Case of Valproic Acid Overdose Treated with Continuous Veno-Venous Hemodiafiltration: A Case Report
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Sang Cheon Choi, Jung Hwan Ahn, Yoon Seok Jung, Young Gi Min
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Korean J Crit Care Med. 2009;24(2):99-101.
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DOI: https://doi.org/10.4266/kjccm.2009.24.2.99
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Abstract
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- Valproic acid intoxication is a fairly common clinical problem that can result in serious complications.
Traditionally the treatment of valproic acid overdose has been limited to supportive measures, but high blood levels may require extracorporeal removal, and publications on this experience are scarce. This case demonstrated continuous veno-venous hemodiafiltration successfully used in patient with severe valproic acid overdose who was hemodynamically unstable.
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