title: Elevation in serum lactate at the time of febrile neutropenia (FN) in hemodynamically-stable patients with hematologic malignancies (HM) is associated with the development of septic shock within 48 hours.
abstract: BACKGROUND
  Hospitalized patients who develop febrile neutropenia (FN) are treated empirically with antibiotics due to a high risk of developing septic shock. Currently, there is no method to predict which patients are at greatest risk. This study was designed to determine whether serum lactate, measured at the time of FN, is associated with the development of septic shock in hospitalized hematologic malignancy (HM) patients.
  
  
  RESULTS
  Of the 547 patients enrolled, 46 (8.4%; 95% CI 6.2-10.9) developed septic shock. Baseline characteristics were similar between the groups. In univariate analysis, tachypnea (OR 5.9; 95% CI: 2.0-16.9, p = 0.001) and lactate (OR 18.4; 95% CI: 4.1-81.6, p < 0.001) were significantly associated with the development of septic shock. In multivariate analysis, lactate and tachypnea remained independently associated with the development of septic shock. By ROC analysis, lactate provided incremental prognostic value compared to vital signs alone.
  
  
  METHODS
  Vital signs and lactate were measured during episodes of FN. The primary endpoint was the development of septic shock. Using a prospective, nested, case-control design, controls were matched on length of stay at the time of septic shock to achieve 80% power to detect an OR of >or=2.5. Using logistic regression, we evaluated the association of vital signs and lactate with the subsequent development of septic shock.
  
  
  CONCLUSIONS
  In FN patients, measurement of lactate during FN adds significant prognostic information about the risk of developing septic shock. Routine measurement of lactate may help identify patients who may benefit from increased monitoring and early intervention strategies.
authors.affiliation: John Theurer Cancer Center, Lymphoma Division, Hackensack University Medical Center, Hackensack, NJ, USA. anthony.mato@uphs.upenn.edu
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Mato
authors.forename: Selina M
authors.initials: SM
authors.lastname: Luger
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Heitjan
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
authors.forename: Erin
authors.initials: E
authors.lastname: Olson
authors.forename: Chaitra
authors.initials: C
authors.lastname: Ujjani
authors.forename: Samantha
authors.initials: S
authors.lastname: Jacobs
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Miltiades
authors.forename: Payal
authors.initials: P
authors.lastname: Shah
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Schuster
authors.forename: Martin
authors.initials: M
authors.lastname: Carroll
authors.forename: Ann Duskin
authors.initials: AD
authors.lastname: Chauffe
authors.forename: Barry D
authors.initials: BD
authors.lastname: Fuchs
mesh_terms: D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000097:blood*; D019337:Hematologic Neoplasms / Q000097:blood*; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009503:Neutropenia / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012772:Shock, Septic / Q000097:blood*
chemical_list: D019344:Lactic Acid