title: Blood Lactate Levels Cutoff and Mortality Prediction in Sepsis-Time for a Reappraisal? a Retrospective Cohort Study.
abstract: The objective of this study was to identify the initial value of blood lactate that best correlates with 28-day mortality in resuscitated septic shock patients. This was a retrospective cohort study including 443 patients admitted to an intensive care unit (ICU) with severe sepsis or septic shock from the emergency department. A receiver-operating characteristic (ROC) curve was drawn to obtain the best cutoff value for initial blood lactate associated with 28-day mortality. Patients were then dichotomized according to the chosen lactate cutoff, and sensitivity, specificity, and positive and negative predictive values were calculated. Baseline blood lactate level more than 2.5 mmol/L showed the largest area under the ROC curve to predict 28-day mortality (ROC area, 0.70; 95% confidence interval [CI], 0.62-0.79), with sensitivity, specificity, and negative predictive value of 67.4%, 61.7%, and 94.2%, respectively. Mortality at 28 days was 16.9% (31/183) in patients with initial lactate more than 2.5 mmol/L and 5.8% (15/260) in patients with initial lactate at most 2.5 mmol/L (relative risk, 2.93; 95% CI, 1.63-5.28; P < 0.001). Initial blood lactate levels more than 2.5 mmol/L (hazard ratio [HR], 2.86; 95% CI, 1.53-5.33; P = 0.001) and Sepsis-related Organ Failure Assessment score at ICU admission (HR, 1.18; 95% CI, 1.09-1.27; P < 0.001) were associated with increased 28-day mortality in the adjusted Cox regression. In this retrospective cohort study, a lactate level more than 2.5 mmol/L was the best threshold to predict 28-day mortality among severe sepsis and septic shock patients. Further prospective studies should address the impact on morbidity and mortality of this threshold as a trigger to resuscitation in this population of critically ill patients.
authors.affiliation: Hospital Israelita Albert Einstein, Intensive Care Unit, São Paulo, Brazil.
authors.forename: Roberto Rabello
authors.initials: RR
authors.lastname: Filho
authors.forename: Leonardo Lima
authors.initials: LL
authors.lastname: Rocha
authors.forename: Thiago Domingos
authors.initials: TD
authors.lastname: Corrêa
authors.forename: Camila Menezes Souza
authors.initials: CM
authors.lastname: Pessoa
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Colombo
authors.forename: Murillo Santucci Cesar
authors.initials: MS
authors.lastname: Assuncao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D019344:Lactic Acid / Q000097:blood*; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000401:mortality*
chemical_list: D019344:Lactic Acid