Association of Clinical Hypoperfusion Variables with Lactate Clearance and Hospital Mortality.
Shock. 2017 Dec 04;:
Authors: Londoño J, Niño C, Díaz J, Morales C, León J, Bernal E, Vargas C, Mejía L, Hincapié C, Ascuntar J, León A, Jaimes F
BACKGROUND: lactate has shown utility in assessing the prognosis of patients admitted to the hospital with confirmed or suspected shock. Some findings of the physical examination might replace it as screening tool. We asked to determine the correlation and association between clinical perfusion parameters and lactate at the time of admission; the correlation between the change in clinical parameters and lactate clearance after 6 and 24 hours of resuscitation and; the association between clinical parameters, lactate and mortality.
METHODS: prospective cohort study of adult patients hospitalized by the emergency room with infection, polytrauma or other causes of hypotension. We measured serum lactate, capillary refill time, shock index and pulse pressure at 0, 6 and 24 hours after admission. A Spearman's correlation was performed between clinical variables and lactate levels, as well as between changes in clinical parameters and lactate clearance. The operative characteristics of those variables were determined by AUC-ROC analysis and the association between lactate, clinical variables and mortality through logistic regression.
RESULTS: 1320 patients met the inclusion criteria, 66.7% (n = 880) confirmed infection, 19% (n = 251) polytrauma and 14.3% (n = 189) another etiology. No significant correlation was found between any clinical variable and lactate values (r < 0.28). None variable had an adequate discriminatory capacity to detect hyperlactatemia (AUC < 0.62). In the multivariate model, lactate value at admission was the only variable independently associated with mortality (OR 1.2; 95%CI = 1.1-1.1) CONCLUSIONS:: Among patients with hypoperfusion risk or shock, no correlation was found between clinical variables and lactate. Of the set of parameters collected, lactate at admission was the only independent marker of mortality.
PMID: 29206763 [PubMed - as supplied by publisher]