title: Use of stepwise lactate kinetics-oriented hemodynamic therapy could improve the clinical outcomes of patients with sepsis-associated hyperlactatemia.
abstract: Setting lactate kinetics at >30% might improve the clinical outcomes of patients with sepsis-associated hyperlactatemia. The aim of this study was to explore the outcome benefits of stepwise lactate kinetics vs central venous oxygen saturation (ScvO2)-oriented hemodynamic therapy at 6 h as the protocol goal during early resuscitation.
  
  
  
  The relevant parameters and adverse events after different targets in 360 randomly assigned patients with sepsis-associated hyperlactatemia were recorded and compared.
  
  
  
  Heart rate (HR) at 48 h in the ScvO2group was higher than in the lactate kinetics group (105 ± 19 bpm vs 99 ± 20 bpm, P = 0.040). The liquid balance at 4 h, 12 h, and 24 h in the lactate kinetics group was larger than in the ScvO2group (1535 (1271-1778) ml vs 826 (631-1219) ml, P < 0.001; 1688 (1173-1923) ml vs 1277 (962 - 1588) ml, P <0.001; and 1510 (904-2087) ml vs 1236 (740-1808) ml, P = 0.005), respectively. Mortality was higher in the ScvO2group (27.9% vs 18.3%, P = 0.033), but there was no significant difference between the two groups in the length of stay in the ICU or mechanical ventilation. In terms of new onset organ dysfunction, there was a significant difference between the two groups in total bilirubin at 48 h and 72 h. Based on the 60-day survival curves, there was significantly more mortality in the ScvO2group than in the lactate kinetics group (X2= 4.133, P = 0.042). In addition, fewer adverse events occurred in the lactate kinetics group.
  
  
  
  Stepwise lactate kinetics-oriented hemodynamic therapy can reduce mortality in patients with sepsis-associated hyperlactatemia compared with ScvO2-oriented therapy.
  
  
  
  National Institutes of Health Clinical Trials Registry, NCT02566460 . Registered on 26 September 2015.
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China. dwliu98@163.com.
authors.forename: Dawei
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
authors.forename: Longxiang
authors.initials: L
authors.lastname: Su
authors.affiliation: Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University Medical College, Qingdao, Shandong Province, 266000, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yao
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Long
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
authors.forename: Xiaoting
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
authors.forename: Wenzhao
authors.initials: W
authors.lastname: Chai
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
authors.forename: Na
authors.initials: N
authors.lastname: Cui
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Rui
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002681:China; D005260:Female; D017408:Guidelines as Topic / Q000592:standards; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D065906:Hyperlactatemia / Q000628:therapy*; D007362:Intensive Care Units / Q000458:organization & administration; D007700:Kinetics; D019344:Lactic Acid / Q000032:analysis* / Q000097:blood; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis / Q000097:blood; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods; D018805:Sepsis / Q000150:complications* / Q000628:therapy; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D019344:Lactic Acid; D010100:Oxygen
keywords: Hemodynamic therapy; Lactate kinetics; ScvO2; Sepsis; Septic shock