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Lactate clearance and mortality in septic patients with hepatic dysfunction

  • Author Footnotes
    1 Contributed equally to this work.
    Tae Sun Ha
    Footnotes
    1 Contributed equally to this work.
    Affiliations
    Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Author Footnotes
    1 Contributed equally to this work.
    Tae Gun Shin
    Footnotes
    1 Contributed equally to this work.
    Affiliations
    Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Ik Joon Jo
    Affiliations
    Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Sung Yeon Hwang
    Affiliations
    Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Chi Ryang Chung
    Affiliations
    Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Gee Young Suh
    Affiliations
    Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Kyeongman Jeon
    Correspondence
    Corresponding author at: Division of Pulmonary and Critical Care Medicine, Department of Medicine and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. Tel.: +82 2 3410 3429; fax: +82 2 3410 3849.
    Affiliations
    Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    1 Contributed equally to this work.
Published:February 25, 2016DOI:https://doi.org/10.1016/j.ajem.2016.02.053

      Abstract

      Background

      Serum lactate clearance (LC) during initial resuscitation is a potentially useful prognostic marker in patients with severe sepsis or septic shock. However, it is unclear whether LC is also associated with the outcome in septic patients with hepatic dysfunction that may impair lactate elimination, which may contribute to elevated serum lactate levels or decreased LC.

      Methods

      The relationships between LC measured within 6 and 24 h after initial resuscitation and hospital mortality were evaluated with multiple logistic regression analysis.

      Results

      Of 770 patients with severe sepsis or septic shock, 208 (27%) with hepatic dysfunction were included in the analysis. The median LC within 6 h in survivors (31.4%) was significantly higher than that of non-survivors (9.3%) (P = .010). In addition, the median LC within 24 h was also significantly different between groups (51% vs. 12%, P < .001). Low LCs, defined as less than 10% of clearance, at 6 and 24 h were associated with in-hospital mortality. After adjusting for potential confounding factors, low LCs at 6 and 24 h remained associated with hospital mortality (adjusted OR 4.940, 95% CI 1.762-13.854 at 6 h; adjusted OR 5.997, 95% CI 2.149-16.737 at 24 h). However, LC at 24 h (area under the curve of 0.704) had higher discriminatory power to predict hospital mortality than LC at 6 h (area under the curve of 0.608) (P = .033).

      Conclusions

      LC may be useful for predicting outcomes in septic patients with hepatic dysfunction.
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