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Normolactatemic Septic Shock: CAUTION - Lethal None The Less FREE TO VIEW

Anja Jaehne, MD; Emanuel Rivers, MD; Victor Coba, MD; Namita Jayaprakash, MD; Alexis Bencze, MD; Brian Steiner, MD; Gina Hurst, MD; Jayna Gardner-Gray, MD; Jacqueline Pflaum, MD; Ryan Worley, MD; Cameron Hypes, MD
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Henry Ford Hospital, Detroit, MI

Chest. 2013;144(4_MeetingAbstracts):410A. doi:10.1378/chest.1702010
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SESSION TITLE: Sepsis and Septic Shock

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM

PURPOSE: Septic shock is associated with either a systolic blood pressure (SBP) below 90 mmHg, mean arterial pressure (MAP) below 65 mmHg, a decrease of 40 mmHg below stable hypertensive blood pressure or lactate greater than 4 mmol/L. When lactate is elevated, lactate clearance has been shown to be clinically useful. The purpose of this study was to examine the frequency and comparative outcome implications in hypotensive patients with normal lactate levels.

METHODS: We analyzed retrospectively data of a sepsis database of patients eligible for the sepsis resuscitation bundle between 2005-2012 at a hospital system comprising 3 hospital sources. Data was analyzed using univariate test by the means of chi-square or student’s t-test as appropriate.

RESULTS: 1828 patients eligible for the RB were identified. Patients were assigned into 4 groups based on the presenting blood pressure (T0) and lactate levels: GROUP 1: SBP < 90 mmHg at T0 and low lactate (lactate < 2 mmol/ L) or normo-lactemic; GROUP 2: SBP < 90 mmHg at T0 and intermediate lactate (lactate 2 to 4 mmol/ L); GROUP 3: SBP < 90 mmHg at T0 and high lactate (lactate > 4 mmol/ L); GROUP 4: SBP > 90 mmHg at T0 and high lactate (lactate > 4 mmol/ L). GROUP 1 with 414 (22.8 %) patients had an observed mortality of 21.1 %, Group 2 with 467 (25.5 %) patients had an observed mortality of 30.6 %, Group 3 with 472 (25.8 %) patients had an observed mortality of 37.9 % and Group 4 with 475 (39.6%) patients had an observed mortality of 29.5 %.

CONCLUSIONS: The incidence of normo-lactemic patients qualifying for the RB was 22.8 % with an associated mortality of 21.1%. The frequency of these patients highlights the limitations of lactate alone as a screening tool for illness severity in septic shock. Furthermore, it limits the utilization of lactate clearance as a guide to resuscitation in septic patients eligible for the RB.

CLINICAL IMPLICATIONS: Normal lactate levels occur in over 1 of every 5 septic patients and are associated with significant mortality. One should be cautious in using lactate alone for risk stratification and lactate clearance as a guide to resuscitation in septic shock.

DISCLOSURE: The following authors have nothing to disclose: Anja Jaehne, Emanuel Rivers, Victor Coba, Namita Jayaprakash, Alexis Bencze, Brian Steiner, Gina Hurst, Jayna Gardner-Gray, Jacqueline Pflaum, Ryan Worley, Cameron Hypes

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