المؤلفون: Lee GT; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Republic of Korea., Hwang SY; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Republic of Korea. Electronic address: sygood.hwang@samsung.com., Park JE; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon, Republic of Korea., Jo IJ; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Kim WY; Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Chung SP; Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea., Jo YH; Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea., Suh GJ; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea., Choi SH; Department of Emergency Medicine, Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea., Shin TG; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: taegunshin@skku.edu.

مؤلفون مشاركون: Korean Shock Society (KoSS) investigators

المصدر: The American journal of emergency medicine [Am J Emerg Med] 2021 Aug; Vol. 46, pp. 392-397. Date of Electronic Publication: 2020 Oct 15.

نوع المنشور: Journal Article; Observational Study

بيانات الدورية: Publisher: W B Saunders Country of Publication: United States NLM ID: 8309942 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8171 (Electronic) Linking ISSN: 07356757 NLM ISO Abbreviation: Am J Emerg Med Subsets: MEDLINE

مواضيع طبية MeSH: Emergency Service, Hospital* , Fluid Therapy*, Lactic Acid/*blood , Resuscitation/*methods , Shock, Septic/*mortality , Shock, Septic/*therapy, Aged ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Registries ; Republic of Korea/epidemiology ; Retrospective Studies

مستخلص: Purpose: The aim of the study was to investigate the diagnostic accuracy of initial and post-fluid resuscitation lactate levels in predicting 28 day mortality.
Materials and Methods: We retrospectively analyzed a multi-center registry of suspected septic shock cases that was prospectively collected between October 2015 and December 2018 from 11 Emergency Departments. The primary outcome was 28 day mortality. The diagnostic performance of the initial and post-fluid resuscitation lactate levels as a predictor for 28 day mortality was assessed.
Results: A total of 2568 patients were included in the final analysis. The overall 28 day mortality rate was 23%. The area under the receiver operating characteristic curve (AUROC) of initial lactate for predicting 28 day mortality was 0.66 (95% CI, 0.64-0.69) and that of after fluid administration lactate was 0.70 (95% CI, 0.67-0.72), and there was a significant difference (p < 0.001). The optimal cutoff point of lactate after fluid administration was 4.4 mmol/L. Compared with this, the Sepsis-3 definition with a lactate level of 2 mmol/L or more was relatively more sensitive and less specific for predicting 28 day mortality.
Conclusion: The post-fluid resuscitation lactate level was more accurate than the initial lactate level in predicting 28 day mortality in patients with suspected septic shock.
Competing Interests: Declaration of Competing Interest The authors have no potential conflicts of interest or funding sources to declare.
(Copyright © 2020 Elsevier Inc. All rights reserved.)

المؤلفون: Ha TS; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Shin TG; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Jo IJ; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Hwang SY; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Chung CR; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Suh GY; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Jeon K; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: kjeon@skku.edu.

المصدر: The American journal of emergency medicine [Am J Emerg Med] 2016 Jun; Vol. 34 (6), pp. 1011-5. Date of Electronic Publication: 2016 Feb 26.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: W B Saunders Country of Publication: United States NLM ID: 8309942 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8171 (Electronic) Linking ISSN: 07356757 NLM ISO Abbreviation: Am J Emerg Med Subsets: MEDLINE

مواضيع طبية MeSH: Lactic Acid/*metabolism , Liver Diseases/*metabolism , Liver Diseases/*mortality , Shock, Septic/*metabolism , Shock, Septic/*mortality, Aged ; Female ; Hospital Mortality ; Humans ; Liver Diseases/complications ; Logistic Models ; Male ; Middle Aged ; Predictive Value of Tests ; Resuscitation ; Shock, Septic/complications

مستخلص: Background: Serum lactate clearance (LC) during initial resuscitation is a potentially useful prognostic marker in patients with severe sepsis or septic shock. However, it is unclear whether LC is also associated with the outcome in septic patients with hepatic dysfunction that may impair lactate elimination, which may contribute to elevated serum lactate levels or decreased LC.
Methods: The relationships between LC measured within 6 and 24h after initial resuscitation and hospital mortality were evaluated with multiple logistic regression analysis.
Results: Of 770 patients with severe sepsis or septic shock, 208 (27%) with hepatic dysfunction were included in the analysis. The median LC within 6h in survivors (31.4%) was significantly higher than that of non-survivors (9.3%) (P=.010). In addition, the median LC within 24h was also significantly different between groups (51% vs. 12%, P<.001). Low LCs, defined as less than 10% of clearance, at 6 and 24h were associated with in-hospital mortality. After adjusting for potential confounding factors, low LCs at 6 and 24h remained associated with hospital mortality (adjusted OR 4.940, 95% CI 1.762-13.854 at 6h; adjusted OR 5.997, 95% CI 2.149-16.737 at 24h). However, LC at 24h (area under the curve of 0.704) had higher discriminatory power to predict hospital mortality than LC at 6h (area under the curve of 0.608) (P=.033).
Conclusions: LC may be useful for predicting outcomes in septic patients with hepatic dysfunction.
(Copyright © 2016 Elsevier Inc. All rights reserved.)