Early lactate clearance for death prediction in severe sepsis or septic shock patients presenting to the Emergency Department
Objective: To analyze the relationship between lactate clearance and in-hospital mortality.
Methods: Retrospective observational study from January 2012 to June 2014. Data abstractors entered clinical and demographic data into database via a web tool created by health system’s Quality Management Institute.
Setting: A multi-hospital health system in New York Metro area with over 500,000 emergency department (ED) visits annually.
Patients: A cohort of patients presenting to eleven emergency departments with severe sepsis or septic shock.
Results: There were 13,925 severe sepsis and septic shock patients during the cohort period. An initial lactate was recorded for 13,196 of these patients, 98% of which had a discharge status listed. The mean initial lactate level was higher for patients that died than for survivors (4.52 +/- 3.66 vs. 2.93 +/- 2.09, respectively; P<.001). 3,901 of the patients with an initial lactate had a repeat lactate within 6 hours of which 3,797 had a discharge status recorded. Mean lactate clearance was 0.24 +/-0.48 for survivors whereas for non-survivors mean lactate clearance was 0.04 +/-0.83 (P<.001). We calculated lactate clearance by the equation (lactate initial – lactate repeat)/lactate initial. Logistic regression was used with lactate clearance as a predictor of mortality adjusting for age, weight, admission unit, hospital, and initial lactate level. The adjusted odds ratio for lactate clearance was 0.50 (95% CI=0.43, 0.59; P<.001). The unadjusted area under the Receiver Operating Characteristic Curve was computed for lactate clearance and in-hospital mortality at 0.62 (95% CI=0.60, 0.64).
Conclusion: Results suggest that improvement in 6 hour lactate clearance among patients admitted from the ED with severe sepsis and septic shock is associated with decreased in-hospital mortality. This information may be useful in assessing the response to short term emergency treatment of severe sepsis in the acute care setting.
Learning Areas:Administration, management, leadership
Describe multi-hospital health system developed sepsis database for evaluation of process and outcome measures. Explain analysis on lactate clearance and the association with improved patient outcomes.
Keyword(s): Data Collection and Surveillance, Mortality
Qualified on the content I am responsible for because: As a biostatistician since 1998 I have worked on various research projects and provided statistical expertise to clinicians for several years. My work at the Krasnoff Quality Management Institute focuses on continually improving the delivery of healthcare by providing statistical support to healthcare administrators and analytical real time web reports to a clinical client base.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.