title: Lactate clearance for death prediction in severe sepsis or septic shock patients during the first 24 hours in Intensive Care Unit: an observational study.
abstract: BACKGROUND
  This study was design to investigate the prognostic value for death at day-28 of lactate course and lactate clearance during the first 24 hours in Intensive Care Unit (ICU), after initial resuscitation.
  
  
  METHODS
  Prospective, observational study in one surgical ICU in a university hospital. Ninety-four patients hospitalized in the ICU for severe sepsis or septic shock were included. In this septic cohort, we measured blood lactate concentration at ICU admission (H0) and at H6, H12, and H24. Lactate clearance was calculated as followed: [(lactateinitial - lactatedelayed)/ lactateinitial] x 100%].
  
  
  RESULTS
  The mean time between severe sepsis diagnosis and H0 (ICU admission) was 8.0 ± 4.5 hours. Forty-two (45%) patients died at day 28. Lactate clearance was higher in survivors than in nonsurvivors patients for H0-H6 period (13 ± 38% and -13 ± 7% respectively, p = 0.021) and for the H0-H24 period (42 ± 33% and -17 ± 76% respectively, p < 0.001). The best predictor of death at day 28 was lactate clearance for the H0-H24 period (AUC = 0.791; 95% CI 0.6-0.85). Logistic regression found that H0-H24 lactate clearance was independently correlated to a survival status with a p = 0.047 [odds ratio = 0.35 (95% CI 0.01-0.76)].
  
  
  CONCLUSIONS
  During the first 24 hr in the ICU, lactate clearance was the best parameter associated with 28-day mortality rate in septic patients. Protocol of lactate clearance-directed therapy should be considered in septic patients, even after the golden hours.
authors: Department of Anesthesiology and Intensive Care, CHU Toulouse, Université Toulouse III Paul Sabatier, Faculté de Médecine Toulouse-Rangueil, EA 4564-MATN, Institut Louis Bugnard (IFR 150), c, F-31000, France. philippemarty@hotmail.com.
authors: Philippe
authors: P
authors: Marty
authors: Antoine
authors: A
authors: Roquilly
authors: Fabrice
authors: F
authors: Vallée
authors: Aymeric
authors: A
authors: Luzi
authors: Fabrice
authors: F
authors: Ferré
authors: Olivier
authors: O
authors: Fourcade
authors: Karim
authors: K
authors: Asehnoune
authors: Vincent
authors: V
authors: Minville
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