title: Lactic acid measurement to identify risk of morbidity from sepsis in pregnancy.
abstract: OBJECTIVE
  This study aims to assess the risk of morbidity associated with maternal lactic acid concentration in women with possible sepsis in pregnancy.
  
  
  METHODS
  Retrospective cohort of pregnant and postpartum patients with signs of sepsis. Morbidity outcomes were compared by lactic acid concentration. Linear regression was used to evaluate the association between lactic acid and adverse outcomes.
  
  
  RESULTS
  Out of the 850 women included, 159 had lactic acid measured. Patients with lactic acid measured had higher morbidity: positive blood cultures (16.8 vs. 5.5%, p = 0.04), admission to the intensive care unit (5 vs. 0.1%, p < 0.01) or acute monitoring unit (17.2 vs. 0.9%, p < 0.01), longer hospital stay (median 3 vs. 2 days, p < 0.01), and preterm delivery (18.3 vs. 10.9%, p = 0.05). The mean lactic concentration was higher in patients admitted to the intensive care (2.6 vs. 1.6 mmol/L, p = 0.04) and telemetry unit (2.0 vs. 1.6, p = 0.03), and in those with positive blood cultures (2.2 vs. 1.6, p < 0.01). Lactic acid was positively associated with intensive care or telemetry unit admission, adjusted odds ratio per 1 mmol/L increase in lactic acid 2.34 (95% confidence interval, 1.33-4.12).
  
  
  CONCLUSIONS
  Elevated lactic acid in pregnancy is associated with adverse maternal outcomes from presumed sepsis. In this cohort, lactic acid measurement was a marker of more severe infection.
authors.affiliation: Division of Maternal Fetal Medicine, Women and Infants Hospital, Brown University, Providence, Rhode Island.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Albright
authors.affiliation: Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Tariq N
authors.initials: TN
authors.lastname: Ali
authors.affiliation: Division of Research, Women and Infants Hospital, Brown University, Providence, Rhode Island.
authors.forename: Vrishali
authors.initials: V
authors.lastname: Lopes
authors.affiliation: Division of Maternal Fetal Medicine, Women and Infants Hospital, Brown University, Providence, Rhode Island.
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.affiliation: Division of Maternal Fetal Medicine, Women and Infants Hospital, Brown University, Providence, Rhode Island.
authors.forename: Brenna L
authors.initials: BL
authors.lastname: Anderson
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood*; D007902:Length of Stay; D016014:Linear Models; D009017:Morbidity; D016017:Odds Ratio; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D047928:Premature Birth; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D019344:Lactic Acid