Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country

Rehman, Fazal; Zafar, Saad Bin; Aziz, Adil; Aziz, Abdul; Memon, Pirbhat Shams; Ejaz, Taymmia; Aziz, Summaira

Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country

The Journal of Critical Care Medicine

Volume 9 (2023): Issue 1 (January 2023)

By:

Fazal Rehman, Saad Bin Zafar, Adil Aziz, Abdul Aziz, Pirbhat Shams Memon, Taymmia Ejaz and Summaira Aziz

Open Access

|Feb 2023

Figures & Tables

Sociodemographic and clinical characteristics of the patients by mortality and organ dysfunction

	Mortality					Organ Dysfunction
Variables	No		Yes		P-Value	No organ dysfunction		Single organ dysfunction		Multi organ dysfunction		P-Value
	n	%	n	%		n	%	n	%	n	%
Age (Years)
20 to 40 Years	54	29.1	3	9.1		21	31.3	23	24.5	7	18.9
41 to 60 years	46	27.9	11	33.3	0.054	18	26.9	27	28.7	12	32.4	0.71
≥ 60 years	71	43	19	57.6		28	41.8	44	46.8	18	48.6

Gender
Male	85	51.5	16	48.5	0.75	35	52.2	49	52.1	17	45.9	0.79
Female	80	48.5	17	51.5		32	47.8	45	47.9	20	54.1

Lactate Clearance
Early	90	78.9	18	54.5	0.005	43	84.3	47	68.1	18	66.7	0.09
Delayed	24	21.1	15	45.5		8	15.7	22	31.9	9	33.3

Diabetes Mellitus
No	128	77.6	15	45.5	<0.001	48	71.6	67	71.3	28	75.7	0.41
Yes	37	22.4	18	54.5		19	28.4	27	28.7	9	24.3

Hypertension
No	115	69.7	13	39.4		41	61.2	66	70.2	21	56.8
Yes	50	30.3	20	60.6	0.001	26	38.8	28	29.8	16	43.2	0.26

Ischemic Heart Disease
No	140	84.8	22	66.7	0.013	58	86.6	73	77.7	31	83.8	0.33
Yes	25	15.2	11	33.3		9	13.4	21	22.3	6	16.2

Chronic kidney disease
No	148	89.7	21	36.4	<0.001	62	92.5	79	84	28	75.7	0.059
Yes	17	10.3	12	63.6		5	7.5	15	16	9	24.3

Chronic Liver Disease
No	159	96.4	29	87.9		67	100	87	92.6	34	91.9
Yes	6	3.6	4	12.1	0.04	0	0	7	7.4	3	8.1	0.06

Lung Disease
No	137	83	22	66.7	0.031	60	89.6	72	76.6	27	73	0.05
Yes	28	17	11	33.3		7	10.4	22	23.4	10	27

Any procedure done
No	147	89.1	20	60.6	<0.001	58	86.6	83	88.3	26	70.3	0.03
Yes	18	10.9	13	39.4		9	13.4	11	11.7	11	29.7

Length of Stay
≤ 7 days	134	81.2	13	39.4		49	73.1	73	77.7	25	67.6
> 7 days	31	18.8	20	60.6	<0.001	18	26.9	21	22.3	12	32.4	0.47

Platelets
>100000	143	86.7	22	66.7	0.005	56	83.6	74	78.7	35	94.6	0.09
Less than 100000	22	13.3	11	33.3		11	16.4	20	21.3	2	5.4

Blood Transfusion
Yes	18	10.9	4	12.1	0.84	9	13.4	9	9.6	4	10.8
No	147	89.1	29	87.9		58	86.6	85	90.4	33	89.2	0.74

Glasgow Coma Scale
Mild (14-15)	144	87.3	7	21.2		54	80.6	73	77.7	24	64.9
Moderate (9-13)	20	12.1	18	54.5	<0.001	11	16.4	19	20.2	8	21.6	0.05
Severe (3-8)	1	0.6	8	24.2		2	3	2	2.1	5	13.5

Association between delayed lactate clearance and mortality and organ dysfunction in patients admitted in a tertiary care hospital (n=198)

	Risk factors for Mortality						Risk factors for Organ Dysfunction
Variables	Crude			Adjusted Estimates			Crude			Adjusted Estimates
	OR	95%CI		AOR	95%CI		OR	95%CI		AOR	95%CI
Age (Years)
20 to 40 Years	1			1			1
41 to 60 years	3.83	1.01	14.59	29.19	0.21	41.5	1.52	0.68	3.34		NA
≥ 60 years	4.28	1.2	15.27	2.77	0.02	33.7	1.55	0.76	3.16

Lactate Clearance
Early	1			1			1			1
Delayed	3.12	1.37	7.09	7.67	1.11	53.26	2.56	1.07	6.13	2.18	0.87	5.49

Diabetes Mellitus
No	1			1			1			1
Yes	4.15	1.91	9.03	8.56	1.18	62.01	0.95	0.49	1.84	0.53	0.22	1.31

Hypertension
No	1			1			1			1
Yes	3.54	1.63	7.67	56.36	3.57	889.83	0.79	0.43	1.47	0.6	0.27	1.33

Chronic kidney disease
No	1						1			1
Yes	4.97	2.08	11.86		NA		1.01	2.78	7.66	6.13	1.72	21.86

Lung Disease
No	1				NA		1			1
Yes	2.46	1.07	5.61				1.15	2.77	6.67	2.61	0.97	6.99

Ischemic Heart Disease
No	1			1			1				NA
Yes	2.8	1.21	6.48	0.15	0.01	1.77	1.67	0.73	3.79

Any procedure done
No	1						1			1
Yes	5.31	2.26	12.45		NA		1.3	0.56	3.01	1.41	0.55	3.63

Length of Stay
≤ 7 days	1			1			1				NA
> 7 days	6.65	2.98	14.8	2.59	0.53	12.7	0.91	0.47	1.79

Platelets
>100000	1			1			1				NA
Less than 100000	3.25	1.38	7.61	305.74	17.9	5195.87	1.03	0.46	2.27

Glasgow Coma Scale
Mild (14-15)	1			1							NA
Moderate (9-13)	18.51	6.87	49.84	134.86	11.17	1627.16	1
Severe (3-8)	164.57	18.01	1504.6	1251.02	28.84	54260.43	1.36	0.63	2.97		NA
CRP	0.98	0.97	0.99	0.97	0.94	1	1.95	0.39	9.71

Sociodemographic and clinical characteristics of the patients admitted in a tertiary care hospital (n=198)

Variables	Frequency (n)	Percentage (%)
Age (Years)
20 to 40 Years	51	25.7
41 to 60 years	57	28.7
≥ 60 years	90	45.45
Gender
Male	101	51
Female	97	49
Hypertension
Yes	70	35.4
No	128	64.6
Diabetes Mellitus
Yes	55	27.8
No	143	72.2
Chronic Kidney Disease
Yes	29	14.6
No	169	85.4
Ischemic Heart Disease
Yes	36	18.2
No	162	81.8
Lung Disease
Yes	39	19.7
No	159	80.3
Chronic Liver Disease
Yes	10	5.1
No	188	94.9
Any Procedures done
Yes	167	84.3
No	31	15.7
Length of stay
≤ 7 days	147	74.2
> 7 days	51	25.8
Platelets
>100000	165	83.3
Less than 100000	33	16.7
Blood Transfusion
Yes	22	11.1
No	176	88.9
Glasgow Coma Scale
Mild (14-15)	151	76.3
Moderate (9-13)	38	19.2
Severe (3-8)	9	4.5

Source of sepsis and organisms grown in cultures

Variables	Frequency (n)	Percentage (%)
Sepsis source
Pneumonia	97	48.9
Viral fever/Dengue Fever	33	16.7
UTI/Pyelonephritis	32	16.2
Enteric fever	9	4.5
Meningitis	8	4
Infected wound/Bedsore	8	4
Spontaneous bacterial	5	2.5
peritonitis
Malaria	3	1.5
Viral hepatitis	3	1.5
Blood cultures
E.coli	10	5.10
Salmonella typhi	9	4.5
Klebsiella	5	2.5
Candida auris	2	1.1
Proteus	1	0.5
Staph aureus	1	0.5
Urine cultures
E.coli	9	4.5
Klebsiella	4	2
Candida	3	1.5
Tracheal cultures
Klebsiella	8	4
Acinetobacter	6	3
Staph aureus	5	2.5
E.coli	2	1.1
Pseudomonas	2	1.1
Candida	1	0.5
Pus cultures
E.coli	5	2.5
Staph aureus	3	1.5
Streptococcus	1	0.5

DOI: https://doi.org/10.2478/jccm-2023-0005 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 30 - 38

Submitted on: Apr 19, 2022

Accepted on: Jan 14, 2023

Published on: Feb 8, 2023

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

sepsis,

lactate,

Related subjects:

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2023 Fazal Rehman, Saad Bin Zafar, Adil Aziz, Abdul Aziz, Pirbhat Shams Memon, Taymmia Ejaz, Summaira Aziz, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

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