Rapid decrease in plasma D-lactate as an early potential predictor of diminished 28-day mortality in critically ill septic shock patients.
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.
Sapin
Vincent
V
Department of Biochemistry, Faculty of Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Nicolet
Laurent
L
Aublet-Cuvelier
Bruno
B
Sangline
Fabienne
F
Roszyk
Laurence
L
Dastugue
Bernard
B
Gazuy
Nicole
N
Deteix
Patrice
P
Souweine
Bertrand
B
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*
D019344:Lactic Acid