Serial plasma lactate measurements in haematological patients with neutropenic fever.
Elevated plasma lactate and impaired lactate clearance have been associated with poor outcome in patients with severe sepsis. No data are available on the kinetics or prognostic value of plasma lactate in haematological patients with neutropenic fever. A total of 70 haematological patients with 94 episodes of neutropenic fever were included into this prospective study during the period 2006-2008. The median age of the patients was 56 (range 18-70) y. Nineteen patients received therapy for acute myeloid leukaemia and 51 patients received autologous stem cell transplantation. At the onset and on days 1, 2, and 3 of each neutropenic fever episode, plasma lactate and serum C-reactive protein were determined. Criteria for severe sepsis were fulfilled in 13 neutropenic episodes. An elevated plasma lactate level was infrequent at the start of neutropenic fever (5%). There was no association of lactate level with the development of severe sepsis. Two patients died of septic shock, 1 patient with an exceptionally high and increasing level of lactate and the other patient with a normal lactate level. An elevated plasma lactate level at the start of neutropenic fever is not common and does not indicate severe sepsis, but high lactate and an impaired lactate decrease may signify a fatal course in neutropenic fever.
Juutilainen
Auni
A
Department of Medicine, Kuopio University Hospital, Kuopio, Finland. auni.juutilainen@kuh.fi
Hämäläinen
Sari
S
Matinlauri
Irma
I
Kuittinen
Taru
T
Nousiainen
Tapio
T
Pulkki
Kari
K
Koivula
Irma
I
Jantunen
Esa
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000473:pathology; D010949:Plasma / Q000737:chemistry*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D055815:Young Adult
D019344:Lactic Acid; D002097:C-Reactive Protein