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Korean J Crit Care Med > Volume 24(3); 2009 > Article
Korean Journal of Critical Care Medicine 2009;24(3): 134-139. doi: https://doi.org/10.4266/kjccm.2009.24.3.134
중증 패혈증 및 패혈성 쇼크 환자에서 예측 인자로서의 시간으로 보정한 젖산 청소율의 유용성
안정환ㆍ최상천ㆍ민영기ㆍ정윤석ㆍ정성희*ㆍ이영주†
아주대학교 의과대학 응급의학교실, *차의과학대학교 마취통증의학교실, †아주대학교 의과대학 마취통증의학교실
The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock
Jung Hwan Ahn, Sang Cheon Choi, Young Gi Min, Yoon Seok Jung, Sung Hee Chung, Young Joo Lee
1Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
2Department of Anesthesiology and Pain Medicine, College of Medicine, CHA University, Pocheon, Korea.
3Department of Anesthesiology, Ajou University School of Medicine, Suwon, Korea. sicuab@hotmail.com
ABSTRACT
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.
Key Words: lactate clearance; prognostic implication; septic shock; severe sepsis
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