title: Lactate Clearance and Vasopressor Seem to Be Predictors for Mortality in Severe Sepsis Patients with Lactic Acidosis Supplementing Sodium Bicarbonate: A Retrospective Analysis.
abstract: BACKGROUND
  Initial lactate level, lactate clearance, C-reactive protein, and procalcitonin in critically ill patients with sepsis are associated with hospital mortality. However, no study has yet discovered which factor is most important for mortality in severe sepsis patients with lactic acidosis. We sought to clarify this issue in patients with lactic acidosis who were supplementing with sodium bicarbonate.
  
  
  METHODS
  Data were collected from a single center between May 2011 and April 2014. One hundred nine patients with severe sepsis and lactic acidosis who were supplementing with sodium bicarbonate were included.
  
  
  RESULTS
  The 7-day mortality rate was 71.6%. The survivors had higher albumin levels and lower SOFA, APACHE II scores, vasopressor use, and follow-up lactate levels at an elapsed time after their initial lactate levels were checked. In particular, a decrement in lactate clearance of at least 10% for the first 6 hours, 24 hours, and 48 hours of treatment was more dominant among survivors than non-survivors. Although the patients who were treated with broad-spectrum antibiotics showed higher illness severity than those who received conventional antibiotics, there was no significant mortality difference. 6-hour, 24-hour, and 48-hour lactate clearance (HR: 4.000, 95% CI: 1.309-12.219, P = 0.015) and vasopressor use (HR: 4.156, 95% CI: 1.461-11.824, P = 0.008) were significantly associated with mortality after adjusting for confounding variables.
  
  
  CONCLUSIONS
  Lactate clearance at a discrete time point seems to be a more reliable prognostic index than initial lactate value in severe sepsis patients with lactic acidosis who were supplementing with sodium bicarbonate. Careful consideration of vasopressor use and the initial application of broad-spectrum antibiotics within the first 48 hours may be helpful for improving survival, and further study is warranted.
authors.affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea.
authors.forename: Su Mi
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea.
authors.forename: Seong Eun
authors.initials: SE
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea.
authors.forename: Eun Bin
authors.initials: EB
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea.
authors.forename: Hyo Jin
authors.initials: HJ
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea.
authors.forename: Young Ki
authors.initials: YK
authors.lastname: Son
authors.affiliation: Department of Internal Medicine, Dong-A University, Busan, Korea.|Institute of Medical Science, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Won Suk
authors.initials: WS
authors.lastname: An
mesh_terms: D000140:Acidosis, Lactic / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D017693:Sodium Bicarbonate / Q000008:administration & dosage*
chemical_list: D019344:Lactic Acid; D017693:Sodium Bicarbonate; D002097:C-Reactive Protein