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Intensive Care Med. 2007 Nov;33(11):1892-9. Epub 2007 Jul 6.

Occult hypoperfusion and mortality in patients with suspected infection.

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  • 1Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Medicine, KB-23, 330 Brookline Avenue, Boston, MA 02215, USA. mhowell@bidmc.harvard.edu

Abstract

OBJECTIVE:

To determine, in the early stages of suspected clinically significant infection, the independent relationship of the presenting venous lactate level to 28-day in-hospital mortality.

DESIGN:

Prospective, observational cohort study.

SETTING:

Urban, university tertiary-care hospital.

PATIENTS:

One thousand two hundred and eighty seven adults admitted through the emergency department who had clinically suspected infection and a lactate measurement.

MEASUREMENTS AND RESULTS:

Seventy-three [5.7% (95% CI 4.4-6.9%)] patients died in the hospital within 28 days. Lactate level was strongly associated with 28-day in-hospital mortality in univariate analysis (p<0.0001). When stratified by blood pressure, lactate remained associated with mortality (p<0.0001). Normotensive patients with a lactate level >or=4.0 mmol/l had a mortality rate of 15.0% (6.0-24%). Patients with either septic shock or lactate >or=4.0 mmol/l had a mortality rate of 28.3% (21.3-35.3%), which was significantly higher than those who had neither [mortality of 2.5% (1.6-3.4%), p<0.0001. In a model controlling for age, blood pressure, malignancy, platelet count, and blood urea nitrogen level, lactate remained strongly associated with mortality. Patients with a lactate level of 2.5-4.0 mmol/l had adjusted odds of death of 2.2 (1.1-4.2); those with lactate >or=4.0 mmol/l had 7.1 (3.6-13.9) times the odds of death. The model had good discrimination (AUC=0.87) and was well calibrated.

CONCLUSIONS:

In patients admitted with clinically suspected infection, the venous lactate level predicts 28-day in-hospital mortality independent of blood pressure and adds significant prognostic information to that provided by other clinical predictors.

PMID:
17618418
DOI:
10.1007/s00134-007-0680-5
[PubMed - indexed for MEDLINE]
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