Serum Lactate Levels In Prognostication Of Patients In Sepsis Or Septic Shock

Introduction: India has recorded a death rate of 7.3 / 1000 individuals in the year 2016. From the multicentric study done on 5,478 ITU admissions, mortality was 59% of which 25% of patient in SIRS with organ dysfunction of which 52.77% were due to sepsis. With such high prevalence, it becomes important to point our focus on early and aggressive measures to reverse sepsis. In a country like India, decision on type and extent of intervention is greatly affected by the financial aspect. Hence, it is important to prognosticate the patient early in order to make treatment decisions. Lactate is one such parameter which denotes sepsis, so we would like to study if serial lactate levels could help prognosticate. Aims and Objective: 1. To measure the lactate levels at the time of presentation and 24 hrs and determine the better predictor of mortality. 2. To compare lactate clearance between survivors and non-survivors. Methodology: It was a prospective observational study. 40 subjects who were in sepsis or septic shock were included in the study and lactate levels were measured at 0hrs and 24 hrs and the lactate clearance was also calculated. Results: Initial lactate levels correlated best to mortality (p-0.003) whereas serial lactate and lactate clearance did not show any positive predictive value. An initial lactate levels of 1.45 could be taken as a cut off for predicting poor mortality and it showed 75% sensitivity and 65% specificity. Discussion: When compared to other studies, certain studies showed near equal correlation of both initial lactate as well as lactate clearance to mortality whereas some other studies showed more correlation between lactate clearance and mortality. Though all our patients received standard care offered to a patient in sepsis but the degree of intervention varied from person to person due to a major concern of financial constraints by relatives. Conclusion: Since initial lactate levels showed good predictability in mortality prediction , it could be used as a parameter to assess prognosis at the initial phase of presentation and thereby determine the extent of intervention to be implemented at the golden hours.