Highlights
- •In sepsis, acidosis and hyperlactatemia occur independently.
- •Acidosis and hyperlactatemia independently predict outcome.
- •The combination of hyperlactatemia and sepsis in a model yielded in higher predictiveness for mortality.
Abstract
Rationale and objectives
Acidosis and hyperlactatemia predict outcome in critically ill patients. We assessed
BE and pH for risk prediction capabilities in a sub-group of septic patients in the
MIMIC-III database.
Methods
Associations with mortality were assessed by logistic regression analysis in 5586
septic patients. Baseline parameters, lactate concentrations, pH, and BE were analyzed
at baseline and after 6 hours.
Measurements and Main Results
We combined acidosis (defined as either BE ≤-6 and/or pH ≤7.3) and hyperlactatemia
and split the cohort into three subgroups: low-risk (no acidosis and lactate <2.3
mmol/L; n = 2294), medium-risk (either acidosis or lactate >2.3 mmol/L; n = 2125)
and high-risk (both acidosis and lactate >2.3 mmol/L; n = 1167). Mortality was 14%,
20% and 38% (p<0.001) in low-risk, medium-risk and high-risk patients, respectively.
The predictiveness of this model (AUC 0.63 95%CI 0.61-0.65) was higher compared to
acidosis (AUC 0.59 95%CI 0.57-0.61; p<0.001) and lactate >2.3 mmol/L (AUC 0.60 95%CI
0.58-0.62; p<0.001) alone. Hyperlactatemia alone was only moderately predictive for
acidosis (AUC 0.60 95%CI 0.59-0.62).
Conclusions
Acidosis and hyperlactatemia can occur independently to a certain degree. Combining
acidosis and hyperlactatemia in a model yielded higher predictiveness for ICU-mortality.
Septic patients with acidosis should be treated even more aggressively in the future.
Keywords
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References
- Surviving Sepsis Campaign Guidelines Committee including the Pediatric S. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.Crit Care Med. 2013; 41: 580-637
- Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine.Crit Care Med. 1998; 26: 1793-1800
- A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study.JAMA. 1993; 270: 2957-2963
- The relationship of base deficit to lactate in porcine hemorrhagic shock and resuscitation.J Trauma. 1994; 36: 168-172
- Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis.Crit Care Med. 1987; 15: 923-929
- Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shock.Intensive Care Med. 1996; 22: 17-25
- A prospective study of the use of a dobutamine stress test to identify outcome in patients with sepsis, severe sepsis, or septic shock.Crit Care Med. 1999; 27: 2361-2366
- Lactate-guided resuscitation saves lives: no.Intensive Care Med. 2016; 42: 470-471
- Group Ls. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial.Am J Respir Crit Care Med. 2010; 182: 752-761
- Early lactate clearance-guided therapy in patients with sepsis: a meta-analysis with trial sequential analysis of randomized controlled trials.Intensive Care Med. 2015; 41: 1862-1863
- Lactate-guided resuscitation saves lives: yes.Intensive Care Med. 2016; 42: 466-469
- Lactate-guided resuscitation saves lives: we are not sure.Intensive Care Med. 2016; 42: 472-474
- Prognostic relevance of serum lactate kinetics in critically ill patients.Intensive Care Med. 2019; 45: 55-61
- Sepsis-associated hyperlactatemia.Crit Care. 2014; 18: 503
- The accuracy of calculated base excess in blood.Clin Chem Lab Med. 2002; 40: 404-410
- Base deficit is superior to pH in evaluating clearance of acidosis after traumatic shock.J Trauma. 1998; 44: 114-118
- Early physiologic predictors of injury severity and death in blunt multiple trauma.Arch Surg. 1990; 125: 498-508
- Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock.Crit Care Med. 1991; 19: 231-243
- Base deficit as a sensitive indicator of compensated shock and tissue oxygen utilization.Surg Gynecol Obstet. 1991; 173: 473-476
- Base deficit in the elderly: a marker of severe injury and death.J Trauma. 1998; 45: 873-877
- Base excess is superior to lactate-levels in prediction of ICU mortality after cardiac surgery.PLoS One. 2018; 13e0205309
- Understanding Lactatemia in Human Sepsis: potential impact for early management.Am J Respir Crit Care Med. 2019;
- Base excess and lactate as prognostic indicators for patients treated by extra corporeal life support after out hospital cardiac arrest due to acute coronary syndrome.Resuscitation. 2014; 85: 1764-1768
- MIMIC-III, a freely accessible critical care database.Sci Data. 2016; 3160035
- Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.Crit Care Med. 2001; 29: 1303-1310
- The trauma triad of death: hypothermia, acidosis, and coagulopathy.AACN Clin Issues. 1999; 10: 85-94
- Fluid resuscitation in severe sepsis.Emerg Med Clin North Am. 2017; 35: 59-74
- Systematic assessment of fluid responsiveness during early septic shock resuscitation: secondary analysis of the ANDROMEDA-SHOCK trial.Crit Care. 2020; 24: 23
- Pooled analysis of higher versus lower blood pressure targets for vasopressor therapy septic and vasodilatory shock.Intensive Care Med. 2018; 44: 12-21
- Target blood pressure for septic and vasodilatory shock: what is optimal?.Intensive Care Med. 2018; 44: 548-549
- Norepinephrine in septic shock: when and how much.Curr Opin Crit Care. 2017; 23: 342-347
- Base deficit is superior to lactate in trauma.Am J Surg. 2018; 215: 682-685
- Clinical use of lactate monitoring in critically ill patients.Ann Intensive Care. 2013; 3: 12
- Understanding the Hyperlactataemia in Sepsis. Are we there yet?.Am J Respir Crit Care Med. 2019;
- Competitive cation binding computations of proton balance for reactions of the phosphagen and glycolytic energy systems within skeletal muscle.PLoS One. 2017; 12e0189822
- Increased aerobic glycolysis through beta2 stimulation is a common mechanism involved in lactate formation during shock states.Shock. 2008; 30: 417-421
- A comparison of epinephrine and norepinephrine in critically ill patients.Intensive Care Med. 2008; 34: 2226-2234
- Severe hyperlactatemia with normal base excess: a quantitative analysis using conventional and Stewart approaches.Crit Care. 2008; 12: R66
Article info
Publication history
Published online: March 03, 2020
Accepted:
February 24,
2020
Received in revised form:
February 15,
2020
Received:
November 10,
2019
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
