Skip to main content
  • Poster presentation
  • Open access
  • Published:

Lactate clearance as a determinant of mortality in surgical patients

Introduction

Serial measurements of lactate over time may be a better prognosticator than a single lactate concentration [1]. Early lactate-guided therapy also reduces ICU length of stay and ICU and hospital mortality [2]. This study aims to assess the prognostic value of the lactate clearance (LC) in the first 24 hours in surgical patients.

Methods

In a prospective cohort during 1 year, we followed consecutively enrolled patients admitted immediately postoperative to the surgical ICU of Hospital Santa Luzia, Brasília, Brazil. Patients were assigned to two groups: LC >10% and LC ≤10%. The primary outcome measure was mortality at 7 and 28 days. The secondary outcome included hospital and ICU length of stay (LOS).

Results

A total of 417 patients were followed. In total, 50.4% were male and 83% underwent elective surgery. The mean age was 59 ± 16, APACHE II score 8 ± 5, SAPS 2 26 ± 11. The mortality at 7 days was 0.95% (n = 4) and the mortality at 28 days was 2.15% (n = 9), respectively. Hospital mortality was 4.79% (n = 20). Sixty-one percent (n = 255) of the patients had LC >10% versus 39% (n = 162) with LC ≤10%. Those who had LC ≤10% were older (62 ± 16 vs. 57 ± 17, P = 0.00) and had greater APACHE II score (9 ± 6 vs. 7 ± 4, P = 0.00) and SAPS 2 (28 ± 12 vs. 25 ± 10, P = 0.02). There was no difference in ICU LOS (5 ± 12 vs. 4 ± 9 days, P = 0.54) and hospital LOS (10 ± 15 vs. 9 ± 11 days, P = 0.48). Initial lactate levels were lower in the group with LC ≤10% (1.1 ± 0.9 vs. 1.9 ± 1.6, P = 0.00); however, mean lactate was higher in 24 hours (2.0 ± 1.8 vs. 1.0 ± 0.7, P = 0.00). All of the patients who died in the first 7 days had LC ≤10% (2.46%, n = 4, P = 0.02); this group also had a higher mortality at 28 days (4.32%, n = 7 vs. 0.78%, n = 2; P = 0.03). The relative risk for mortality LC ≤10% in 7 and 28 days was 1.02 (95% CI: 1.00 to 1.05) and 5.07 (95% CI: 1.17 to 27.09), respectively. Significant difference was observed in the Kaplan-Meier survival curves for 7 and 28 days (P = 0.01 and 0.02, respectively). The sensibility of LC ≤10% was 100% (95% CI: 51 to 100%) for 7-day mortality and 78% (95% CI: 45 to 94%) for 28-day mortality. The specificity was 62% (95% CI: 57 to 66%) for 7-day mortality and 62% (95% CI: 57 to 66%) for 28-day mortality.

Conclusion

Despite initial lactate levels, lactate clearance ≤10% proved to be a good predictor of mortality in 7 and 28 days in surgical patients admitted in the postoperative period to the ICU.

References

  1. Nguyen HB, et al.: Crit Care Med. 2004, 32: 1637-1642. 10.1097/01.CCM.0000132904.35713.A7

    Article  PubMed  Google Scholar 

  2. Jansen TC, et al.: Am J Respir Crit Care Med. 2010, 182: 752-756. 10.1164/rccm.200912-1918OC

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Amorim, F., Moura, E., Santana, A. et al. Lactate clearance as a determinant of mortality in surgical patients. Crit Care 17 (Suppl 2), P216 (2013). https://0-doi-org.brum.beds.ac.uk/10.1186/cc12154

Download citation

  • Published:

  • DOI: https://0-doi-org.brum.beds.ac.uk/10.1186/cc12154

Keywords