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Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country
BACKGROUND: Single lactate measurements have been reported to have prognostic significance, however, there is a lack of data in local literature from Pakistan. This study was done to determine prognostic role of lactate clearance in sepsis patients being managed in our lower-middle income country. M...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Sciendo
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987270/ https://www.ncbi.nlm.nih.gov/pubmed/36890975 http://dx.doi.org/10.2478/jccm-2023-0005 |
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author | Rehman, Fazal Zafar, Saad Bin Aziz, Adil Aziz, Abdul Memon, Pirbhat Shams Ejaz, Taymmia Aziz, Summaira |
author_facet | Rehman, Fazal Zafar, Saad Bin Aziz, Adil Aziz, Abdul Memon, Pirbhat Shams Ejaz, Taymmia Aziz, Summaira |
author_sort | Rehman, Fazal |
collection | PubMed |
description | BACKGROUND: Single lactate measurements have been reported to have prognostic significance, however, there is a lack of data in local literature from Pakistan. This study was done to determine prognostic role of lactate clearance in sepsis patients being managed in our lower-middle income country. METHODS: This prospective cohort study was conducted from September 2019-February 2020 at the Aga Khan University Hospital, Karachi. Patients were enrolled using consecutive sampling and categorized based on their lactate clearance status. Lactate clearance was defined as decrease by 10% or greater in repeat lactate from the initial measurement (or both initial and repeat levels <=2.0 mmol/L). RESULTS: A total 198 patients were included in the study, 51% (101) were male. Multi-organ dysfunction was reported in 18.6% (37), 47.7% (94) had single organ dysfunction, and 33.8% (67) had no organ dysfunction. Around 83% (165) were discharged and 17% (33) died. There were missing data for 25.8% (51) of the patients for the lactate clearance, whereas 55% (108) patients had early lactate clearance and 19.7% (39) had delayed lactate clearance.On univariate analysis, mortality rate was higher in patients with delayed lactate clearance (38.4% vs 16.6%) and patients were 3.12 times (OR = 3.12; [95% CI: 1.37-7.09]) more likely to die as compared with early lactate clearance. Patients with delayed lactate clearance had higher organ dysfunction (79.4% vs 60.1%) and were 2.56 (OR = 2.56; [95% CI: 1.07-6.13]) times likely to have organ dysfunction. On multivariate analysis, after adjusting for age and co-morbids, patients with delayed lactate clearance were 8 times more likely to die than patients with early lactate clearance [aOR = 7.67; 95% CI:1.11-53.26], however, there was no statistically significant association between delayed lactate clearance [aOR = 2.18; 95% CI: 0.87-5.49)] and organ dysfunction. CONCLUSION: Lactate clearance is a better determinant of sepsis and septic shock effective management. Early lactate clearance is related to better outcomes in septic patients. |
format | Online Article Text |
id | pubmed-9987270 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Sciendo |
record_format | MEDLINE/PubMed |
spelling | pubmed-99872702023-03-07 Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country Rehman, Fazal Zafar, Saad Bin Aziz, Adil Aziz, Abdul Memon, Pirbhat Shams Ejaz, Taymmia Aziz, Summaira J Crit Care Med (Targu Mures) Research Article BACKGROUND: Single lactate measurements have been reported to have prognostic significance, however, there is a lack of data in local literature from Pakistan. This study was done to determine prognostic role of lactate clearance in sepsis patients being managed in our lower-middle income country. METHODS: This prospective cohort study was conducted from September 2019-February 2020 at the Aga Khan University Hospital, Karachi. Patients were enrolled using consecutive sampling and categorized based on their lactate clearance status. Lactate clearance was defined as decrease by 10% or greater in repeat lactate from the initial measurement (or both initial and repeat levels <=2.0 mmol/L). RESULTS: A total 198 patients were included in the study, 51% (101) were male. Multi-organ dysfunction was reported in 18.6% (37), 47.7% (94) had single organ dysfunction, and 33.8% (67) had no organ dysfunction. Around 83% (165) were discharged and 17% (33) died. There were missing data for 25.8% (51) of the patients for the lactate clearance, whereas 55% (108) patients had early lactate clearance and 19.7% (39) had delayed lactate clearance.On univariate analysis, mortality rate was higher in patients with delayed lactate clearance (38.4% vs 16.6%) and patients were 3.12 times (OR = 3.12; [95% CI: 1.37-7.09]) more likely to die as compared with early lactate clearance. Patients with delayed lactate clearance had higher organ dysfunction (79.4% vs 60.1%) and were 2.56 (OR = 2.56; [95% CI: 1.07-6.13]) times likely to have organ dysfunction. On multivariate analysis, after adjusting for age and co-morbids, patients with delayed lactate clearance were 8 times more likely to die than patients with early lactate clearance [aOR = 7.67; 95% CI:1.11-53.26], however, there was no statistically significant association between delayed lactate clearance [aOR = 2.18; 95% CI: 0.87-5.49)] and organ dysfunction. CONCLUSION: Lactate clearance is a better determinant of sepsis and septic shock effective management. Early lactate clearance is related to better outcomes in septic patients. Sciendo 2023-02-08 /pmc/articles/PMC9987270/ /pubmed/36890975 http://dx.doi.org/10.2478/jccm-2023-0005 Text en © 2023 Fazal Rehman, Saad Bin Zafar, Adil Aziz, Abdul Aziz, Pirbhat Shams Memon, Taymmia Ejaz, Summaira Aziz, published by Sciendo https://creativecommons.org/licenses/by/4.0/This work is licensed under the Creative Commons Attribution 4.0 International License. |
spellingShingle | Research Article Rehman, Fazal Zafar, Saad Bin Aziz, Adil Aziz, Abdul Memon, Pirbhat Shams Ejaz, Taymmia Aziz, Summaira Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country |
title | Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country |
title_full | Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country |
title_fullStr | Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country |
title_full_unstemmed | Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country |
title_short | Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country |
title_sort | early lactate clearance as a determinant of survival in patients with sepsis: findings from a low-resource country |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987270/ https://www.ncbi.nlm.nih.gov/pubmed/36890975 http://dx.doi.org/10.2478/jccm-2023-0005 |
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