Previous lactate clearance cut off for early mortality prediction in sepsis and septic shock patients was determined by consensus from small sample size-study. This study investigated the best lactate clearance cut off and its ability for early mortality prediction in sepsis and septic shock patients.

Methods

A cohort study of adult sepsis and septic shock patients was conducted in Intensive Care Unit, Cipto Mangunkusumo Hospital. We recorded patients’ lactate clearance, eight other end points resuscitation and observed their outcome during first 120 hours of hospitalization. Best lactate clearance cut off for early mortality prediction was determined using receiver operating characteristic (ROC) analysis. The lactate clearance cut off ability for early mortality prediction was investigated with Cox’s proportional hazard regression analysis using other end points resuscitation as confounders.

Results

As many as 268 subjects were included in this study, of whom 70 (26.11%) subjects not survive at 120 hours observation. The area under ROC of lactate clearance to predict early mortality was 0.78 (95% % confidence interval [CI] 0.71-0.84) with best cut off was <7.5% (sensitivity and specificity 88.99% and 81.4% respectively). Compared with group achieving lactate clearance target, group not achieving lactate clearance target had increase early mortality risk (adjusted hazard ratio 13.42; 95%CI 7.19-25.07).

 

Conclusions

The best lactate clearance cut off for early mortality prediction in sepsis and septic shock patients is 7.5%. Using that cut off, lactate clearance is an independent predictor of mortality in sepsis and septic shock patients.

 

Key words: cut off, lactate clearance, sepsis, septic shock