Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock

被引:61
作者
Thomas-Rueddel, Daniel O. [1 ,2 ]
Poidinger, Bernhard [1 ]
Weiss, Manfred [3 ]
Bach, Friedhelm [4 ]
Dey, Karin [5 ]
Haeberle, Helene [6 ]
Kaisers, Udo [7 ]
Rueddel, Hendrik [1 ,2 ]
Schaedler, Dirk [8 ]
Scheer, Christian [9 ]
Schreiber, Torsten [10 ]
Schuerholz, Tobias [11 ]
Simon, Philipp [7 ]
Sommerer, Armin [5 ]
Schwarzkopf, Daniel [2 ]
Weyland, Andreas [12 ]
Woebker, Gabriele [13 ]
Reinhart, Konrad [1 ,2 ]
机构
[1] Jena Univ Hosp, Dept Anesthesia & Intens Care Med, D-07740 Jena, Germany
[2] Jena Univ Hosp, Integrated Res & Treatment Ctr Sepsis Control & C, D-07740 Jena, Germany
[3] Univ Hosp Ulm, Dept Anesthesiol, Ulm, Germany
[4] Ev Krankenhaus Bielefeld, Dept Anesthesiol Intens Care Med Emergency Med &, Bielefeld, Germany
[5] Bundeswehrkrankenhaus Berlin, Dept Anesthesiol & Intens Care Med, Berlin, Germany
[6] Univ Tubingen Hosp, Dept Anesthesiol & Intens Care Med, Tubingen, Germany
[7] Univ Hosp Leipzig, Dept Anesthesiol & Intens Care Med, Leipzig, Germany
[8] Univ Med Ctr Schleswig Holstein, Dept Anesthesiol & Intens Care Med, Kiel, Germany
[9] Univ Greifswald, Dept Anesthesiol & Intens Care Med, Greifswald, Germany
[10] Zent Klin Bad Berka GmbH, Dept Anesthesiol & Intens Care Med, Bad Berka, Germany
[11] Univ Hosp Aachen, Dept Intens Care Med, Aachen, Germany
[12] Hosp Oldenburg, Dept Anesthesiol Intens Care Med Emergency Med &, Oldenburg, Germany
[13] HELIOS Klinikum Wuppertal, Dept Intens Care Med, Wuppertal, Germany
关键词
Sepsis; Septic shock; Lactic acid; Critical care; GOAL-DIRECTED THERAPY; ORGAN FAILURE; SERUM LACTATE; HYDROCORTISONE; RESUSCITATION; DEFINITIONS; HYPOTENSION; DOBUTAMINE; GUIDELINES; MANAGEMENT;
D O I
10.1016/j.jcrc.2014.10.027
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: Current guidelines and most trials do not consider elevated lactate (Lac) serum concentrations when grading sepsis severity. We therefore assessed the association of different types of circulatory dysfunction regarding presence of hyperlactatemia and need for vasopressor support with clinical presentation and outcome of sepsis. Methods: In a secondary analysis of a prospective observational multicenter cohort study, 988 patients with severe sepsis were investigated regarding vasopressor support, Lac levels, and outcome. Results: Twenty-eight-day mortality regarding shock or hyperlactatemia was as follows: hyperlactatemia more than 2.5 mmol/L and septic shock (tissue dysoxic shock): 451 patients with a mortality of 44.8%; hyperlactatemia without vasopressor need (cryptic shock): 72 patients, mortality 35.3%; no hyperlactatemia with vasopressor need (vasoplegic shock): 331 patients, mortality 27.7%; and absence of hyperlactemia or overt shock (severe sepsis): 134 patients, mortality 14.2% (P < .001). These groups showed differences in source and origin of infection. The influence of hyperlactatemia on 28-day mortality (P < .001) (odds ratio 3.0, 95% confidence interval 2.1-4.1 for Lac >4 mmol/L) was independent of vasopressor support (P < .001) (odds ratio 2.0, 95% confidence interval 1.3-3.0 for norepinephrine >0.1 mu g/kg per minute) in logistic regression. Conclusions: Hyperlactatemia increases risk of death independent of vasopressor need resulting in different phenotypes within the classic categories of severe sepsis and septic shock. (C) 2014 Elsevier Inc. All rights reserved.
引用
收藏
页码:439 / U288
页数:6
相关论文
共 34 条
  • [1] Mechanisms of sepsis-induced organ dysfunction
    Abraham, Edward
    Singer, Mervyn
    [J]. CRITICAL CARE MEDICINE, 2007, 35 (10) : 2408 - 2416
  • [2] Mottling score predicts survival in septic shock
    Ait-Oufella, H.
    Lemoinne, S.
    Boelle, P. Y.
    Galbois, A.
    Baudel, J. L.
    Lemant, J.
    Joffre, J.
    Margetis, D.
    Guidet, B.
    Maury, E.
    Offenstadt, G.
    [J]. INTENSIVE CARE MEDICINE, 2011, 37 (05) : 801 - 807
  • [3] Etiology and Therapeutic Approach to Elevated Lactate Levels
    Andersen, Lars W.
    Mackenhauer, Julie
    Roberts, Jonathan C.
    Berg, Katherine M.
    Cocchi, Michael N.
    Donnino, Michael W.
    [J]. MAYO CLINIC PROCEEDINGS, 2013, 88 (10) : 1127 - 1140
  • [4] Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock
    Annane, D
    Sébille, V
    Charpentier, C
    Bollaert, PE
    François, B
    Korach, JM
    Capellier, G
    Cohen, Y
    Azoulay, E
    Troché, G
    Chaumet-Riffaut, P
    Bellissant, E
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2002, 288 (07): : 862 - 871
  • [5] Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock:: a randomised trial
    Annane, Djillali
    Vignon, Philippe
    Renault, Alain
    Bollaert, Pierre-Edouard
    Charpentier, Claire
    Martin, Claude
    Troche, Gilles
    Ricard, Jean-Damien
    Nitenberg, Gerard
    Papazian, Laurent
    Azoulay, Elie
    Bellissant, Eric
    [J]. LANCET, 2007, 370 (9588) : 676 - 684
  • [6] Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study
    Bloos, Frank
    Thomas-Ruddel, Daniel
    Rueddel, Hendrik
    Engel, Christoph
    Schwarzkopf, Daniel
    Marshall, John C.
    Harbarth, Stephan
    Simon, Philipp
    Riessen, Reimer
    Keh, Didier
    Dey, Karin
    Weiss, Manfred
    Toussaint, Susanne
    Schaedler, Dirk
    Weyland, Andreas
    Ragaller, Maximillian
    Schwarzkopf, Konrad
    Eiche, Juergen
    Kuhnle, Gerhard
    Hoyer, Heike
    Hartog, Christiane
    Kaisers, Udo
    Reinhart, Konrad
    [J]. CRITICAL CARE, 2014, 18 (02)
  • [7] DEFINITIONS FOR SEPSIS AND ORGAN FAILURE AND GUIDELINES FOR THE USE OF INNOVATIVE THERAPIES IN SEPSIS
    BONE, RC
    BALK, RA
    CERRA, FB
    DELLINGER, RP
    FEIN, AM
    KNAUS, WA
    SCHEIN, RMH
    SIBBALD, WJ
    [J]. CHEST, 1992, 101 (06) : 1644 - 1655
  • [8] Mitochondrial dysfunction in sepsis
    David Brealey
    Mervyn Singer
    [J]. Current Infectious Disease Reports, 2003, 5 (5) : 365 - 371
  • [9] Cleveland W. S., 2017, Statistical Models in S, P309, DOI [10.1201/9780203738535, DOI 10.1201/9780203738535, DOI 10.1201/9780203738535-8]
  • [10] The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects
    De Backer, D
    Creteur, J
    Dubois, MJ
    Sakr, Y
    Koch, M
    Verdant, C
    Vincent, JL
    [J]. CRITICAL CARE MEDICINE, 2006, 34 (02) : 403 - 408