Risk factors for mortality in patients with low lactate level and septic shock

Dong Hyun Oh, Moo Hyun Kim, Woo Yong Jeong, Yong Chan Kim, Eun Jin Kim, Je Eun Song, In Young Jung, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, Young Goo Song, June Myung Kim

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: According to the new definition of septic shock, vasopressor therapy and hyperlactatemia are essential for diagnosis. However, there is controversy regarding the cutoff value for lactate, and prognostic factors in patients with septic shock and hypolactatemia. This study evaluated the prognostic significance of the cutoff value for lactate level in septic shock patients. Methods: The retrospective observational cohort study enrolled 1043 patients aged ≥18 years who meet the revised definition of septic shock. Clinical outcomes of patients with hyperlactatemia were compared with hypolactatemia. Results: Of the 1022 eligible patients, 369 had an arterial lactate level ≤2 mmol/L. More patients in the high lactate group had poor prognosis than in the low lactate group. A high Sequential Organ Failure Assessment score (SOFA) score group was significant (p < 0.001) in predicting lactate levels. On the subgroup analysis of risk factors affecting mortality in the low lactate group, high Acute Physiology And Chronic Health Evaluation Ⅱ (APACHEⅡ) score (p = 0.003), high C-reactive protein (p = 0.034), and chronic heart failure (p = 0.001) were independently associated with 28-day mortality. Conclusion: Arterial lactate is a very reliable diagnostic and prognostic predictor of septic shock. However, despite low arterial lactate, patients with a high APACHEⅡ score, high C-reactive protein levels, and chronic heart failure had a poorer prognosis.

Original languageEnglish
Pages (from-to)418-425
Number of pages8
JournalJournal of Microbiology, Immunology and Infection
Volume52
Issue number3
DOIs
Publication statusPublished - 2019 Jun

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Septic Shock
Lactic Acid
Mortality
APACHE
C-Reactive Protein
Heart Failure
Organ Dysfunction Scores
Convulsive Therapy
Observational Studies
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Oh, D. H., Kim, M. H., Jeong, W. Y., Kim, Y. C., Kim, E. J., Song, J. E., ... Kim, J. M. (2019). Risk factors for mortality in patients with low lactate level and septic shock. Journal of Microbiology, Immunology and Infection, 52(3), 418-425. https://doi.org/10.1016/j.jmii.2017.08.009
Oh, Dong Hyun ; Kim, Moo Hyun ; Jeong, Woo Yong ; Kim, Yong Chan ; Kim, Eun Jin ; Song, Je Eun ; Jung, In Young ; Jeong, Su Jin ; Ku, Nam Su ; Choi, Jun Yong ; Song, Young Goo ; Kim, June Myung. / Risk factors for mortality in patients with low lactate level and septic shock. In: Journal of Microbiology, Immunology and Infection. 2019 ; Vol. 52, No. 3. pp. 418-425.
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abstract = "Background: According to the new definition of septic shock, vasopressor therapy and hyperlactatemia are essential for diagnosis. However, there is controversy regarding the cutoff value for lactate, and prognostic factors in patients with septic shock and hypolactatemia. This study evaluated the prognostic significance of the cutoff value for lactate level in septic shock patients. Methods: The retrospective observational cohort study enrolled 1043 patients aged ≥18 years who meet the revised definition of septic shock. Clinical outcomes of patients with hyperlactatemia were compared with hypolactatemia. Results: Of the 1022 eligible patients, 369 had an arterial lactate level ≤2 mmol/L. More patients in the high lactate group had poor prognosis than in the low lactate group. A high Sequential Organ Failure Assessment score (SOFA) score group was significant (p < 0.001) in predicting lactate levels. On the subgroup analysis of risk factors affecting mortality in the low lactate group, high Acute Physiology And Chronic Health Evaluation Ⅱ (APACHEⅡ) score (p = 0.003), high C-reactive protein (p = 0.034), and chronic heart failure (p = 0.001) were independently associated with 28-day mortality. Conclusion: Arterial lactate is a very reliable diagnostic and prognostic predictor of septic shock. However, despite low arterial lactate, patients with a high APACHEⅡ score, high C-reactive protein levels, and chronic heart failure had a poorer prognosis.",
author = "Oh, {Dong Hyun} and Kim, {Moo Hyun} and Jeong, {Woo Yong} and Kim, {Yong Chan} and Kim, {Eun Jin} and Song, {Je Eun} and Jung, {In Young} and Jeong, {Su Jin} and Ku, {Nam Su} and Choi, {Jun Yong} and Song, {Young Goo} and Kim, {June Myung}",
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Oh, DH, Kim, MH, Jeong, WY, Kim, YC, Kim, EJ, Song, JE, Jung, IY, Jeong, SJ, Ku, NS, Choi, JY, Song, YG & Kim, JM 2019, 'Risk factors for mortality in patients with low lactate level and septic shock', Journal of Microbiology, Immunology and Infection, vol. 52, no. 3, pp. 418-425. https://doi.org/10.1016/j.jmii.2017.08.009

Risk factors for mortality in patients with low lactate level and septic shock. / Oh, Dong Hyun; Kim, Moo Hyun; Jeong, Woo Yong; Kim, Yong Chan; Kim, Eun Jin; Song, Je Eun; Jung, In Young; Jeong, Su Jin; Ku, Nam Su; Choi, Jun Yong; Song, Young Goo; Kim, June Myung.

In: Journal of Microbiology, Immunology and Infection, Vol. 52, No. 3, 06.2019, p. 418-425.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk factors for mortality in patients with low lactate level and septic shock

AU - Oh, Dong Hyun

AU - Kim, Moo Hyun

AU - Jeong, Woo Yong

AU - Kim, Yong Chan

AU - Kim, Eun Jin

AU - Song, Je Eun

AU - Jung, In Young

AU - Jeong, Su Jin

AU - Ku, Nam Su

AU - Choi, Jun Yong

AU - Song, Young Goo

AU - Kim, June Myung

PY - 2019/6

Y1 - 2019/6

N2 - Background: According to the new definition of septic shock, vasopressor therapy and hyperlactatemia are essential for diagnosis. However, there is controversy regarding the cutoff value for lactate, and prognostic factors in patients with septic shock and hypolactatemia. This study evaluated the prognostic significance of the cutoff value for lactate level in septic shock patients. Methods: The retrospective observational cohort study enrolled 1043 patients aged ≥18 years who meet the revised definition of septic shock. Clinical outcomes of patients with hyperlactatemia were compared with hypolactatemia. Results: Of the 1022 eligible patients, 369 had an arterial lactate level ≤2 mmol/L. More patients in the high lactate group had poor prognosis than in the low lactate group. A high Sequential Organ Failure Assessment score (SOFA) score group was significant (p < 0.001) in predicting lactate levels. On the subgroup analysis of risk factors affecting mortality in the low lactate group, high Acute Physiology And Chronic Health Evaluation Ⅱ (APACHEⅡ) score (p = 0.003), high C-reactive protein (p = 0.034), and chronic heart failure (p = 0.001) were independently associated with 28-day mortality. Conclusion: Arterial lactate is a very reliable diagnostic and prognostic predictor of septic shock. However, despite low arterial lactate, patients with a high APACHEⅡ score, high C-reactive protein levels, and chronic heart failure had a poorer prognosis.

AB - Background: According to the new definition of septic shock, vasopressor therapy and hyperlactatemia are essential for diagnosis. However, there is controversy regarding the cutoff value for lactate, and prognostic factors in patients with septic shock and hypolactatemia. This study evaluated the prognostic significance of the cutoff value for lactate level in septic shock patients. Methods: The retrospective observational cohort study enrolled 1043 patients aged ≥18 years who meet the revised definition of septic shock. Clinical outcomes of patients with hyperlactatemia were compared with hypolactatemia. Results: Of the 1022 eligible patients, 369 had an arterial lactate level ≤2 mmol/L. More patients in the high lactate group had poor prognosis than in the low lactate group. A high Sequential Organ Failure Assessment score (SOFA) score group was significant (p < 0.001) in predicting lactate levels. On the subgroup analysis of risk factors affecting mortality in the low lactate group, high Acute Physiology And Chronic Health Evaluation Ⅱ (APACHEⅡ) score (p = 0.003), high C-reactive protein (p = 0.034), and chronic heart failure (p = 0.001) were independently associated with 28-day mortality. Conclusion: Arterial lactate is a very reliable diagnostic and prognostic predictor of septic shock. However, despite low arterial lactate, patients with a high APACHEⅡ score, high C-reactive protein levels, and chronic heart failure had a poorer prognosis.

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