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Early lactate clearance is associated with biomarkers of inflammation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock.

Nguyen HB, Loomba M, Yang JJ, Jacobsen G, Shah K, Otero RM, Suarez A, Parekh H, Jaehne A, Rivers EP - J Inflamm (Lond) (2010)

Bottom Line: The mean levels of all biomarkers and organ dysfunction scores over 72 hours were significantly lower with higher lactate clearance quartiles (p < 0.01).There was a significant decreased in-hospital, 28-day, and 60-day mortality in the higher lactate clearance quartiles (p < 0.01).Early lactate clearance as a surrogate for the resolution of global tissue hypoxia is significantly associated with decreased levels of biomarkers, improvement in organ dysfunction and outcome in severe sepsis and septic shock.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine, Loma Linda University, Loma Linda, CA. hbryantn@yahoo.com.

ABSTRACT

Background: Lactate clearance, a surrogate for the magnitude and duration of global tissue hypoxia, is used diagnostically, therapeutically and prognostically. This study examined the association of early lactate clearance with selected inflammatory, coagulation, apoptosis response biomarkers and organ dysfunction scores in severe sepsis and septic shock.

Methods: Measurements of serum arterial lactate, biomarkers (interleukin-1 receptor antagonist, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor-alpha, intercellular adhesion molecule-1, high mobility group box-1, D-Dimer and caspase-3), and organ dysfunction scores (Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Multiple Organ Dysfunction Score, and Sequential Organ Failure Assessment) were obtained in conjunction with a prospective, randomized study examining early goal-directed therapy in severe sepsis and septic shock patients presenting to the emergency department (ED). Lactate clearance was defined as the percent change in lactate levels after six hours from a baseline measurement in the ED.

Results: Two-hundred and twenty patients, age 65.0 +/- 17.1 years, were examined, with an overall lactate clearance of 35.5 +/- 43.1% and in-hospital mortality rate of 35.0%. Patients were divided into four quartiles of lactate clearance, -24.3 +/- 42.3, 30.1 +/- 7.5, 53.4 +/- 6.6, and 75.1 +/- 7.1%, respectively (p < 0.01). The mean levels of all biomarkers and organ dysfunction scores over 72 hours were significantly lower with higher lactate clearance quartiles (p < 0.01). There was a significant decreased in-hospital, 28-day, and 60-day mortality in the higher lactate clearance quartiles (p < 0.01).

Conclusions: Early lactate clearance as a surrogate for the resolution of global tissue hypoxia is significantly associated with decreased levels of biomarkers, improvement in organ dysfunction and outcome in severe sepsis and septic shock.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier 12-month survival analysis based on lactate clearance quartile. Lactate clearance quartile 1, 2, 3, and 4 have lactate clearance of -24.3 ± 42.3, 30.1 ± 7.5, 53.4 ± 6.6, and 75.1 ± 7.1%, respectively, during the first 6 hours in the emergency department (p < 0.01).
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Figure 3: Kaplan-Meier 12-month survival analysis based on lactate clearance quartile. Lactate clearance quartile 1, 2, 3, and 4 have lactate clearance of -24.3 ± 42.3, 30.1 ± 7.5, 53.4 ± 6.6, and 75.1 ± 7.1%, respectively, during the first 6 hours in the emergency department (p < 0.01).

Mentions: There was significant decreased in-hospital, 28-day and 60-day mortality for higher lactate clearance quartiles (Table 4). Kaplan-Meier survival analysis showed a survival benefit over 12 months for patients in the higher lactate clearance quartiles (Figure 3).


Early lactate clearance is associated with biomarkers of inflammation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock.

Nguyen HB, Loomba M, Yang JJ, Jacobsen G, Shah K, Otero RM, Suarez A, Parekh H, Jaehne A, Rivers EP - J Inflamm (Lond) (2010)

Kaplan-Meier 12-month survival analysis based on lactate clearance quartile. Lactate clearance quartile 1, 2, 3, and 4 have lactate clearance of -24.3 ± 42.3, 30.1 ± 7.5, 53.4 ± 6.6, and 75.1 ± 7.1%, respectively, during the first 6 hours in the emergency department (p < 0.01).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2837000&req=5

Figure 3: Kaplan-Meier 12-month survival analysis based on lactate clearance quartile. Lactate clearance quartile 1, 2, 3, and 4 have lactate clearance of -24.3 ± 42.3, 30.1 ± 7.5, 53.4 ± 6.6, and 75.1 ± 7.1%, respectively, during the first 6 hours in the emergency department (p < 0.01).
Mentions: There was significant decreased in-hospital, 28-day and 60-day mortality for higher lactate clearance quartiles (Table 4). Kaplan-Meier survival analysis showed a survival benefit over 12 months for patients in the higher lactate clearance quartiles (Figure 3).

Bottom Line: The mean levels of all biomarkers and organ dysfunction scores over 72 hours were significantly lower with higher lactate clearance quartiles (p < 0.01).There was a significant decreased in-hospital, 28-day, and 60-day mortality in the higher lactate clearance quartiles (p < 0.01).Early lactate clearance as a surrogate for the resolution of global tissue hypoxia is significantly associated with decreased levels of biomarkers, improvement in organ dysfunction and outcome in severe sepsis and septic shock.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine, Loma Linda University, Loma Linda, CA. hbryantn@yahoo.com.

ABSTRACT

Background: Lactate clearance, a surrogate for the magnitude and duration of global tissue hypoxia, is used diagnostically, therapeutically and prognostically. This study examined the association of early lactate clearance with selected inflammatory, coagulation, apoptosis response biomarkers and organ dysfunction scores in severe sepsis and septic shock.

Methods: Measurements of serum arterial lactate, biomarkers (interleukin-1 receptor antagonist, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor-alpha, intercellular adhesion molecule-1, high mobility group box-1, D-Dimer and caspase-3), and organ dysfunction scores (Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Multiple Organ Dysfunction Score, and Sequential Organ Failure Assessment) were obtained in conjunction with a prospective, randomized study examining early goal-directed therapy in severe sepsis and septic shock patients presenting to the emergency department (ED). Lactate clearance was defined as the percent change in lactate levels after six hours from a baseline measurement in the ED.

Results: Two-hundred and twenty patients, age 65.0 +/- 17.1 years, were examined, with an overall lactate clearance of 35.5 +/- 43.1% and in-hospital mortality rate of 35.0%. Patients were divided into four quartiles of lactate clearance, -24.3 +/- 42.3, 30.1 +/- 7.5, 53.4 +/- 6.6, and 75.1 +/- 7.1%, respectively (p < 0.01). The mean levels of all biomarkers and organ dysfunction scores over 72 hours were significantly lower with higher lactate clearance quartiles (p < 0.01). There was a significant decreased in-hospital, 28-day, and 60-day mortality in the higher lactate clearance quartiles (p < 0.01).

Conclusions: Early lactate clearance as a surrogate for the resolution of global tissue hypoxia is significantly associated with decreased levels of biomarkers, improvement in organ dysfunction and outcome in severe sepsis and septic shock.

No MeSH data available.


Related in: MedlinePlus