The Relationship Between Initial Lactate And Short-term Prognosis Of Sepsis:A Cohort Study

Objective Clarify the relationship between initial lactate and short-term prognosis in septic patients who met Sepsis-3 criteria.Methods In this retrospective cohort study,182 patients who met the sepsis-3 criteria in the emergency intensive care unit(EICU)of The First Affiliated Hospital of University of South China from September 1,2014 to June 30,2017 were collected.The general condition of admission and initial lactate and procalcitonin and organ function,early treatment and short-term prognosis of all participants were collected and analyzed.Short-term prognostic indicators: the primary outcome was 28-day mortality,and secondary outcome indicators included 48-hour mortality and EICU staying.Univariate analysis,logistic regression analysis and stratified analysis were used to explore the relationship between initial plasma lactate and short-term prognosis of sepsis.Result 1.The study included 182 cases of sepsis patients who met the Sepsis-3 criteria,65 cases(35.71%)28-day mortality,23 cases(12.63%)48-hour mortality,and the median of EICU staying is 4 days.2.Grouped according to levels of lactate,compared with LAC < 4mmol/L group,LAC?4mmol/L group in the 28-day mortality and 48-hour mortality were significantly increased(P<0.001),but no significant differences on EICU staying between the two groups(P=0.083).3.Grouped according to 28-day prognosis,compared with the survival group,the initial lactate,age,serum creatinine level,urea nitrogen level and invasive ventilation ratio increased significantly in the 28-day mortality group,and the GCS coma score,oxygenation index and serum albumin level decreased significantly(P < 0.05).There was no significant difference in the 6-hour infusion volume,the time of first dose of antibiotics and the use of vasoconstrictor drugs between the two groups(P > 0.05).4.Univariate analysis showed that increased initial lactate is a risk factor for early sepsis 28-day mortality(OR,1.29;95%CI,1.15-1.44);The risk of 28-day mortality was significantly increased in people who with initial lactate levels of 4mmol/L or greater(OR,4.34;95%CI,2.26-8.37).5.Initial lactate is an risk factor for the 28-day mortality of sepsis After adjusted for potential confounding factors(adjusted odds ratio,adj-OR,1.30;95%CI,1.14-1.48);The risk of 28-day mortality was significantly increased in people who with initial lactate levels of 4mmol/L or greater(adjOR,3.86;95%CI,1.64-9.07).6.Further stratification analysis was carried out according to the level of procalcitonin(PCT),results show in adjusted: In the low(adj-OR,1.19;95%CI,1.07-1.57),middle(adj-OR,1.27;95%CI,1.05-1.79)and high(adjOR,1.61;95%CI,1.20-2.31)PCT level,the hyperlactoemia was associated with the 28-day mortality of sepsis,and the correlation increased gradually.7.Initial lactate is an risk factor for the 48-hour mortality of sepsis in unadjusted(OR,1.37;95%CI,1.12-1.56)and adjusted(adj-OR,1.35;95%CI,1.17-1.56)analyses.The risk of 48-hour mortality was significantly increased in people who with initial lactate levels of 4mmol/L or greater(adjusted OR,5.24;95%CI,1.64-16.76).8.There was no significant correlation between initial lactate and the EICU staying in unadjusted(?,-0.18;95%CI,-0.46-0.10)and adjusted(adjusted ?,-0.16;95%CI,-0.36-0.03)analyses.There was also no significant difference EICU staying between the LAC?4mmol/L group and the LAC<4mmol/L group after adjusted(?,-0.12;95%CI,-1.51-1.27)analyses.Conclusions Among patients who met the sepsis-3 standard,initial lactate is an risk factor for the 28-day mortality and 48-hour mortality of sepsis.After stratification by procalcitonin,the accuracy of initial lactate risk stratification for sepsis was improved.