Donnino, Michael W

Dugas, Andrea

Joyce, Nina

Mackenhauer, Julie

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

English

PubMed

Julie Mackenhauer

Andrea Dugas

Nina Joyce

Michael W Donnino

Springer - Publisher Connector

Prevalence and characteristics of non-lactate and lactate expressors in septic shock

ORAL PRESENTATION Open Access
Prevalence and characteristics of non-lactate and
lactate expressors in septic shock
Julie Mackenhauer1,2*, Andrea Dugas1, Nina Joyce1, Michael W Donnino1
From Danish Society for Emergency Medicine: Research Symposium 2010
Roskilde, Denmark. 20-21 May 2010
Background
Although elevated lactate levels are associated with
increased mortality in sepsis, not all patients with septic
shock express lactic acidosis. The objective of this study
was to determine the proportion of patients in vasopres-
sor-dependent septic shock who presented with and
without lactic acidosis. Secondarily, we sought to deter-
mine patient characteristics that differentiated lactate
expressors and non-lactate expressors.
Hypothesis: Patients in septic shock often do not have
an elevated lactate, and still face significant mortality.
Methods
Retrospective review of patients presenting between 01/
08 and 09/08, to an urban tertiary care emergency
department (50,000 patients year). Patients with a pre-
sumed diagnosis of septic shock requiring vasopressors
were divided, based on initial lactate, to low (0-2.4),
intermediate (2.5 - 3.9) and high (4.0 and higher) lactate
groups. We used descriptive statistics to report the data
and chi-squared or t-test as appropriate to compare
groups.
Results
A total of 138 patients with vasopressor-dependent
shock were enrolled. Of these, 64/138 (46%) were non-
lactate expressors (low lactate levels), and 54% of the
population were lactate expressors, with 33/138 (24%) in
the intermediate elevation group and 41/138 (30%) in
the high lactate group. The 28-day mortality increased
significantly with increasing lactate with 19%, 30%, and
44% mortality within the low, intermediate and high lac-
tate group respectively (p = 0.021). Acute liver failure
statistically correlated with higher lactate levels with 4%
(5/64), 16% (4/33), and 34% (15/41) prevalence as the
lactate group increased from low, intermediate to high
(p < 0.001). Similarly, liver disease and liver enzymes
trended in the same direction. Bacteremia increased sig-
nificantly between lactate groups with 9% (6/64) in the
normal lactate, 15% (5/33) in the intermediate lactate
and 34% (14/41) in the high lactate group having posi-
tive blood cultures (p = 0.005).
Conclusion
Almost one-half of patients with vasopressor-dependent
septic shock do not express lactic acidosis on presenta-
tion, though a high mortality rate remains in this popu-
lation. The use of lactic acidosis as the only indication
of perfusion status or endpoint of resuscitation in septic
shock may be inadequate. We found an association
between lactate expressors and acute liver failure and
the prevalence of positive blood cultures.
Author details
1Beth Israel Deaconess Medical Center, Emergency Department, Boston, USA.
2Research Center for Emergency Medicine, Aarhus University Hospital,
Aarhus, Denmark.
Published: 17 September 2010
doi:10.1186/1757-7241-18-S1-O2
Cite this article as: Mackenhauer et al.: Prevalence and characteristics of
non-lactate and lactate expressors in septic shock. Scandinavian Journal
of Trauma, Resuscitation and Emergency Medicine 2010 18(Suppl 1):O2.
* Correspondence: thejuliemac@gmail.com
1Beth Israel Deaconess Medical Center, Emergency Department, Boston, USA
Full list of author information is available at the end of the article
Mackenhauer et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2010, 18(Suppl 1):O2
http://www.sjtrem.com/content/18/S1/O2
© 2010 Mackenhauer et al; licensee BioMed Central Ltd.


Crossref

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine

https://sjtrem.biomedcentral.com/track/pdf/10.1186/1757-7241-18-S1-O2?site=sjtrem.biomedcentral.com

Prevalence and characteristics of non-lactate and lactate expressors in septic shock

Abstract

Similar works

Full text

Available Versions

Springer - Publisher Connector

Springer - Publisher Connector

Crossref