title: Rapid decrease in plasma D-lactate as an early potential predictor of diminished 28-day mortality in critically ill septic shock patients.
abstract: BACKGROUND
  Splanchnic ischemia plays a major role in the development of organ failure during septic shock. Plasma D-lactate has been proposed as a better marker of splanchnic hypoperfusion than L-lactate. We studied the prognostic ability of plasma D- and L-lactate levels.
  
  
  METHODS
  A prospective study was performed in an intensive care unit and included patients with septic shock. Two samples for plasma D- and L-lactate determination were collected: the first within 6 h after the patient met the criteria for septic shock (day 1) and the second 24 h later (day 2).
  
  
  RESULTS
  In univariate analysis, day 1 plasma D- and L-lactate values were associated with 28-day mortality. For plasma D- and L- lactate, the area under the receiver operating characteristic curve was 0.68+/-0.09 and 0.84+/-0.07 on day 1 (p=0.09), and 0.74+/-0.10 and 0.90+/-0.07 on day 2 (p=0.06), respectively. In survivors, D-lactate levels decreased between day 1 and day 2 (p=0.03), but L-lactate did not (p=0.29). In septic shock patients, plasma D- and L-lactate levels reliably discriminate between survivors and non-survivors. The prognostic ability of plasma L-lactate was better than that of plasma D-lactate.
  
  
  CONCLUSIONS
  A rapid decrease in plasma D-lactate during the course of septic shock could indicate reduced 28-day mortality.
authors.affiliation: Department of Biochemistry, Faculty of Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Sapin
authors.forename: Laurent
authors.initials: L
authors.lastname: Nicolet
authors.forename: Bruno
authors.initials: B
authors.lastname: Aublet-Cuvelier
authors.forename: Fabienne
authors.initials: F
authors.lastname: Sangline
authors.forename: Laurence
authors.initials: L
authors.lastname: Roszyk
authors.forename: Bernard
authors.initials: B
authors.lastname: Dastugue
authors.forename: Nicole
authors.initials: N
authors.lastname: Gazuy
authors.forename: Patrice
authors.initials: P
authors.lastname: Deteix
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D006801:Humans; D007700:Kinetics; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality*
chemical_list: D019344:Lactic Acid