The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study

Abstract Whether lactate clearance (LC) influences outcomes differently depending on the infection site in sepsis cases is not fully elucidated. Herein, we analyzed LC’s clinical utility as a predictor of patient outcomes according to infection site. This retrospective study, conducted at two tertia...

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Autores principales:	Momoko Sugimoto, Wataru Takayama, Kiyoshi Murata, Yasuhiro Otomo
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/49d4040fb6de41a6a2290f71ffb543b4
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spelling	oai:doaj.org-article:49d4040fb6de41a6a2290f71ffb543b42021-11-21T12:22:54ZThe impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study10.1038/s41598-021-01856-52045-2322https://doaj.org/article/49d4040fb6de41a6a2290f71ffb543b42021-11-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-01856-5https://doaj.org/toc/2045-2322Abstract Whether lactate clearance (LC) influences outcomes differently depending on the infection site in sepsis cases is not fully elucidated. Herein, we analyzed LC’s clinical utility as a predictor of patient outcomes according to infection site. This retrospective study, conducted at two tertiary emergency critical care medical centers in Japan, included patients with sepsis or septic shock. The associations between infection site (lungs vs. other organs) and in-hospital mortality and ventilator-free days (VFDs) were evaluated using univariable and multivariate analyses. We assessed LC’s ability to predict in-hospital mortality using the area under the receiver operating characteristic curve. Among 369 patients with sepsis, infection sites were as follows: lungs, 186 (50.4%); urinary tract, 45 (12.2%); abdomen, 102 (27.6%); and other, 36 (9.8%). Patients were divided into a pneumonia group or non-pneumonia group depending on their infection site. The pneumonia group displayed a higher in-hospital mortality than the non-pneumonia group (24.2% vs. 15.8%, p = 0.051). In the multivariate analysis, lower LC was associated with higher in-hospital mortality [adjusted odds ratio (AOR), 0.97; 95% confidence interval (CI) 0.96–0.98; p < 0.001] and fewer VFD [adjusted difference p value (AD), − 1.23; 95% CI − 2.42 to − 0.09; p = 0.025] in the non-pneumonia group. Conversely, LC did not affect in-hospital mortality (AOR 0.99; 95% CI 0.99–1.00; p = 0.134) and VFD (AD − 0.08; 95% CI − 2.06 to 1.91; p = 0.854) in the pneumonia group. Given the differences in the impact of LC on outcomes between the pneumonia and non-pneumonia groups, this study suggests that optimal treatment strategies might improve outcomes. Further studies are warranted to validate our results and develop optimal therapeutic strategies for sepsis patients.Momoko SugimotoWataru TakayamaKiyoshi MurataYasuhiro OtomoNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Momoko Sugimoto Wataru Takayama Kiyoshi Murata Yasuhiro Otomo The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study
description	Abstract Whether lactate clearance (LC) influences outcomes differently depending on the infection site in sepsis cases is not fully elucidated. Herein, we analyzed LC’s clinical utility as a predictor of patient outcomes according to infection site. This retrospective study, conducted at two tertiary emergency critical care medical centers in Japan, included patients with sepsis or septic shock. The associations between infection site (lungs vs. other organs) and in-hospital mortality and ventilator-free days (VFDs) were evaluated using univariable and multivariate analyses. We assessed LC’s ability to predict in-hospital mortality using the area under the receiver operating characteristic curve. Among 369 patients with sepsis, infection sites were as follows: lungs, 186 (50.4%); urinary tract, 45 (12.2%); abdomen, 102 (27.6%); and other, 36 (9.8%). Patients were divided into a pneumonia group or non-pneumonia group depending on their infection site. The pneumonia group displayed a higher in-hospital mortality than the non-pneumonia group (24.2% vs. 15.8%, p = 0.051). In the multivariate analysis, lower LC was associated with higher in-hospital mortality [adjusted odds ratio (AOR), 0.97; 95% confidence interval (CI) 0.96–0.98; p < 0.001] and fewer VFD [adjusted difference p value (AD), − 1.23; 95% CI − 2.42 to − 0.09; p = 0.025] in the non-pneumonia group. Conversely, LC did not affect in-hospital mortality (AOR 0.99; 95% CI 0.99–1.00; p = 0.134) and VFD (AD − 0.08; 95% CI − 2.06 to 1.91; p = 0.854) in the pneumonia group. Given the differences in the impact of LC on outcomes between the pneumonia and non-pneumonia groups, this study suggests that optimal treatment strategies might improve outcomes. Further studies are warranted to validate our results and develop optimal therapeutic strategies for sepsis patients.
format	article
author	Momoko Sugimoto Wataru Takayama Kiyoshi Murata Yasuhiro Otomo
author_facet	Momoko Sugimoto Wataru Takayama Kiyoshi Murata Yasuhiro Otomo
author_sort	Momoko Sugimoto
title	The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study
title_short	The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study
title_full	The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study
title_fullStr	The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study
title_full_unstemmed	The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study
title_sort	impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/49d4040fb6de41a6a2290f71ffb543b4
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The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study

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