Lactate clearance as a predictor of 24-hour mortality in sepsis patients

BACKGROUND: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. One of the elements of Surviving Sepsis Campaign (SSC) Hour-1 Bundle is to measure lactate levels and re-measure when the initial lactate level is >2 mmol/L. Several studies have shown that lactate clearance provides a more effective prognostic value, therefore lactate clearance has been recommended as an initial goal of therapy and is associated with clinical improvement in septic patients. The aim of this study is to assess lactate clearance as a predictor of mortality in septic patients.METHODS: Study prognostic test involving 50 septic shock subjects at Wahidin Sudirohusodo General Hospital and other networks. Lactate levels were measured at the time of diagnosis of septic shock (H0), then measured again after 1 hour (H1) and 6 hours (H6). From these serial measurements, the lactate clearance value was obtained with the formula (lactate initial-lactate delayed)/lactate initialx 100%]. Statistical analysis using the Kolmogrov-Smirnov Test, Mann-Whitney Test, Chi-square Test, ROC Curve to assess the AUC and determine the cutoff lactate clearance value. The test results are significant if the P value <0.05.RESULTS: Among 50 subjects in this study, it was found that women dominated (56%) with the highest age frequency distribution was <60 years (62%). Subject with comorbidities (74%) were more than those without comorbidities (26%), whereas the distribution of outcomes <24 hours was found to have a similar distribution. Comparison of lactate clearance with outcome showed that the mean lactate clearance was found to be significantly lower in subjects non-survivor compared to the survivor (P<0.005). Lactate clearance H0-H6 provides the most accurate prognostic value for mortality in septic shock patients with sensitivity 88%, specificity 76%, positive predictive value 79%, negative predictive value 86%, and accuracy 82%.CONCLUSIONS: The lactate clearance value can be used as a predictor of 24-hour mortality in sepsis patients.