PURPOSE: The presence of an elevated serum lactate level is associated with morbidity and mortality in patients with severe sepsis. In patients with hepatic dysfunction, however, elevated serum lactate level may be due to either impaired lactate clearance or excessive production. Therefore, we evaluated weather initial serum lactate level is also associated with mortality in septic shock patients with hepatic dysfunction.
METHODS: Retrospective observational study was performed with 360 patients with septic shock admitted to ICU between May 2007 and July 2009. Hepatic dysfunction was defined as serum total bilirubin more than 2mg/dL. Selected patients were divided in high (≥ 4 mmol/L) and low (< 4 mmol/L) lactate group according to initial serum lactate level.
RESULTS: Out of 360 patients with septic shock, 119 (33%) patients with hepatic dysfunction were eligible for this study. There were 50 patients in high lactate group and 69 patients were in low lactate group. Mean lactate levels were 7.54 ± SD mmol/L for high lactate group and 2.47 ± SD mmol/L for low lactate group (p < 0.001). Mortality at 28 days was 37.5% in high lactate group and 25.4% in low lactate group (p < 0.001). After adjusting for potential confounding factors, initial serum lactate level remained significantly associated with mortality (OR, 1.50; 95% CI 1.12 - 2.02; p = 0.003).
CONCLUSION: Initial serum lactate level was independently associated with 28-day mortality rate, even in septic shock patients with hepatic dysfunction.
CLINICAL IMPLICATIONS: The measurement of serum lactate level could be useful in predicting outcome of patients with septic shock regardless of hepatic dysfunction.
DISCLOSURE: Yeh Rim Kang, No Financial Disclosure Information; No Product/Research Disclosure Information