Intensive Care Medicine

, Volume 33, Issue 6, pp 970–977 | Cite as

Serum lactate as a predictor of mortality in patients with infection

  • Stephen Trzeciak
  • R. Phillip Dellinger
  • Michael E. Chansky
  • Ryan C. Arnold
  • Christa Schorr
  • Barry Milcarek
  • Steven M. Hollenberg
  • Joseph E. Parrillo
Original

Abstract

Objective

To determine the utility of an initial serum lactate measurement for identifying high risk of death in patients with infection.

Design and setting

Post-hoc analysis of a prospectively compiled registry in an urban academic hospital.

Participants

Patients with (a) a primary or secondary diagnosis of infection and (b) lactate measurement who were admitted over the 18 months following hospital-wide implementation of the Surviving Sepsis Campaign guideline for lactate measurement in patients with infection and possible severe sepsis. There were 1,177 unique patients, with an in-hospital mortality of 19%.

Measurements and results

Outcome measures included acute-phase (≤ 3 days) death and in-hospital death. We defined lactate ranges a priori (low, 0.0–2.0; intermediate, 2.1–3.9; high, 4.0 mmol/l or above)—and tested for linear associations with mortality by one-way analysis of variance. We determined sensitivity/specificity, odds ratios, and likelihood ratios for a lactate ≥ 4.0 mmol/l and performed a Bayesian analysis to determine its impact on a full range (0.01–0.99) of hypothetical pretest probability estimates for death. In-hospital mortality was 15%, 25%, and 38% in low, intermediate, and high lactate groups, respectively. Acute-phase deaths and in-hospital deaths increased linearly with lactate. An initial lactate ≥ 4.0 mmol/l was associated with sixfold higher odds of acute-phase death; however, a lactate level less than 4 mmol/l had little impact on probability of death.

Conclusions

When broadly implemented in routine practice, measurement of lactate in patients with infection and possible sepsis can affect assessment of mortality risk. Specifically, an initial lactate ≥ 4.0 mmol/l substantiallyincreases the probability of acute-phase death.

Keywords

Lactic acid Bayesian prediction In-hospital mortality Infection Sepsis Severe sepsis Septic shock 

Supplementary material

134_2007_563_MOESM1_ESM.doc (46 kb)
Electronic Supplementary Material (DOC 46K)

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Stephen Trzeciak
    • 1
  • R. Phillip Dellinger
    • 1
  • Michael E. Chansky
    • 1
  • Ryan C. Arnold
    • 1
  • Christa Schorr
    • 1
  • Barry Milcarek
    • 1
  • Steven M. Hollenberg
    • 1
  • Joseph E. Parrillo
    • 1
  1. 1.Division of Cardiovascular Disease and Critical Care Medicine and the Department of Emergency MedicineUMDNJ-Robert Wood Johnson Medical School at Camden, Cooper University HospitalCamdenUSA

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