title: Lactate clearance is associated with mortality in septic patients with acute kidney injury requiring continuous renal replacement therapy: A cohort study.
abstract: The aim of the study was to assess the clinical utility of lactate measured at different time points to predict mortality at 48 hours and 28 days in septic patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).Consecutive critically ill patients with septic AKI requiring CRRT were prospectively studied. Variables were collected at initiation of CRRT and 24 hours later.In total, 186 patients were analyzed. Overall mortality at 48 hours was 28% and at 28 days was 69%. Initial lactate, lactate at 24 hours and the proportion of patients with a lactate clearance superior to 10% were different between survivors at 28 days [2.0 mmol/L, 1.95 mmol/L and 18/45 (40%)] and nonsurvivors [3.46 mmol, 4.66 mmol, and 18/94 (19%)]. Multivariate analysis demonstrated that lactate at 24 hours and lactate clearance, but not initial lactate, were independently associated to mortality. Area under the ROC curves for 28-day mortality was 0.635 for initial lactate; 0.828 for lactate at 24 hours and 0.701 for lactate clearance.Lactate clearance and lactate after 24 hours of CRRT, but not initial lactate, were independently associated with mortality in septic AKI patients undergoing CRRT. Serial lactate measurements may be useful prognostic markers than initial lactate in these patients.
authors.affiliation: Critical Care Unit Hospital Sao Rafael, Salvador, Brazil /Nephrology Division Hospital Portugues, Salvador Critical Care Unit Hospital São Rafael, Salvador, Brazil/UNIME Medical School, Lauro de Freitas Critical Care Unit Hospital São Rafael Nephrology Division, Hospital Português, Salvador Hospital São Rafael Critical Care Unit Hospital São Rafael, Salvador, Brazil/UNIME Medical School, Lauro de Freitas, Brazil.
authors.forename: Rogério da Hora
authors.initials: RDH
authors.lastname: Passos
authors.forename: Joao Gabriel Rosa
authors.initials: JGR
authors.lastname: Ramos
authors.forename: André
authors.initials: A
authors.lastname: Gobatto
authors.forename: Evandro José Bulhões
authors.initials: EJB
authors.lastname: Mendonça
authors.forename: Eva Alves
authors.initials: EA
authors.lastname: Miranda
authors.forename: Fábio Ricardo Dantas
authors.initials: FRD
authors.lastname: Dutra
authors.forename: Maria Fernanda R
authors.initials: MFR
authors.lastname: Coelho
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Pedroza
authors.forename: Paulo Benigno Pena
authors.initials: PBP
authors.lastname: Batista
authors.forename: Margarida Maria Dantas
authors.initials: MMD
authors.lastname: Dutra
mesh_terms: D058186:Acute Kidney Injury / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001938:Brazil / Q000453:epidemiology; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D008297:Male; D011379:Prognosis; D012372:ROC Curve; D017582:Renal Replacement Therapy / Q000379:methods*; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000378:metabolism* / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019344:Lactic Acid