Significance of lactate clearance in septic shock patients with high bilirubin levels

Abstract Lactate clearance is affected by hepatic function. However, it is unclear whether the association between hepatic dysfunction and lactate clearance can act as a prognostic marker of clinical outcomes in patients with septic shock. We aimed to evaluate the association between lactate clearan...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Nozomi Takahashi, Taka-aki Nakada, Keith R. Walley, James A. Russell
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7f98fea2fe824db2aace8bf0c8db4980
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:7f98fea2fe824db2aace8bf0c8db4980
record_format	dspace
spelling	oai:doaj.org-article:7f98fea2fe824db2aace8bf0c8db49802021-12-02T13:18:00ZSignificance of lactate clearance in septic shock patients with high bilirubin levels10.1038/s41598-021-85700-w2045-2322https://doaj.org/article/7f98fea2fe824db2aace8bf0c8db49802021-03-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-85700-whttps://doaj.org/toc/2045-2322Abstract Lactate clearance is affected by hepatic function. However, it is unclear whether the association between hepatic dysfunction and lactate clearance can act as a prognostic marker of clinical outcomes in patients with septic shock. We aimed to evaluate the association between lactate clearance and mortality in two cohorts of septic shock patient who had hepatic dysfunction based on their total serum bilirubin levels (TBIL). Lactate clearance at 24 h after the onset of septic shock was analyzed using two cohorts, sub-categorized into two groups based on TBIL: < 2 mg/dL and ≥ 2 mg/dL. In the derivation cohort, lactate clearance was lower in non-survivors than in survivors with TBIL ≥ 2 mg/dL, while there was no significant difference in lactate clearance between non-survivors and survivors with TBIL < 2 mg/dL. Multivariate logistic regression analysis revealed that increased lactate clearance was significantly associated with decreased 28-day mortality in the TBIL ≥ 2 mg/dL group (10% lactate clearance, adjusted odds ratio [OR]: 0.88, 95% confidence interval (CI): 0.80–0.97, P = 0.0075), Creatinine level ≥ 2 mg/dL group (adjusted OR: 0.88, 95% CI: 0.81–0.95, P = 0.00069) and APACHE II score ≥ 35 group (adjusted OR: 0.93, 95% CI: 0.87–0.98, P = 0.013). In the validation cohort, lactate clearance was lower in non-survivors than in survivors with TBIL ≥ 2 mg/dL, while no significant difference in lactate clearance was observed between non-survivors and survivors with TBIL < 2 mg/dL. Increased lactate clearance was significantly associated with decreased 28-day mortality in the TBIL ≥ 2 mg/dL group (10% lactate clearance, adjusted OR: 0.89, 95% CI: 0.83–0.96, P = 0.0038) and the association was just about significant in APACHE II score ≥ 35 group (adjusted OR: 0.86, 95% CI: 0.74–1.00, P = 0.051). In conclusion, increased lactate clearance in septic shock patients with hepatic dysfunction (TBIL ≥ 2 mg/dL) or high severity (APACHE II score ≥ 35) was associated with decreased 28-day mortality.Nozomi TakahashiTaka-aki NakadaKeith R. WalleyJames A. RussellNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Nozomi Takahashi Taka-aki Nakada Keith R. Walley James A. Russell Significance of lactate clearance in septic shock patients with high bilirubin levels
description	Abstract Lactate clearance is affected by hepatic function. However, it is unclear whether the association between hepatic dysfunction and lactate clearance can act as a prognostic marker of clinical outcomes in patients with septic shock. We aimed to evaluate the association between lactate clearance and mortality in two cohorts of septic shock patient who had hepatic dysfunction based on their total serum bilirubin levels (TBIL). Lactate clearance at 24 h after the onset of septic shock was analyzed using two cohorts, sub-categorized into two groups based on TBIL: < 2 mg/dL and ≥ 2 mg/dL. In the derivation cohort, lactate clearance was lower in non-survivors than in survivors with TBIL ≥ 2 mg/dL, while there was no significant difference in lactate clearance between non-survivors and survivors with TBIL < 2 mg/dL. Multivariate logistic regression analysis revealed that increased lactate clearance was significantly associated with decreased 28-day mortality in the TBIL ≥ 2 mg/dL group (10% lactate clearance, adjusted odds ratio [OR]: 0.88, 95% confidence interval (CI): 0.80–0.97, P = 0.0075), Creatinine level ≥ 2 mg/dL group (adjusted OR: 0.88, 95% CI: 0.81–0.95, P = 0.00069) and APACHE II score ≥ 35 group (adjusted OR: 0.93, 95% CI: 0.87–0.98, P = 0.013). In the validation cohort, lactate clearance was lower in non-survivors than in survivors with TBIL ≥ 2 mg/dL, while no significant difference in lactate clearance was observed between non-survivors and survivors with TBIL < 2 mg/dL. Increased lactate clearance was significantly associated with decreased 28-day mortality in the TBIL ≥ 2 mg/dL group (10% lactate clearance, adjusted OR: 0.89, 95% CI: 0.83–0.96, P = 0.0038) and the association was just about significant in APACHE II score ≥ 35 group (adjusted OR: 0.86, 95% CI: 0.74–1.00, P = 0.051). In conclusion, increased lactate clearance in septic shock patients with hepatic dysfunction (TBIL ≥ 2 mg/dL) or high severity (APACHE II score ≥ 35) was associated with decreased 28-day mortality.
format	article
author	Nozomi Takahashi Taka-aki Nakada Keith R. Walley James A. Russell
author_facet	Nozomi Takahashi Taka-aki Nakada Keith R. Walley James A. Russell
author_sort	Nozomi Takahashi
title	Significance of lactate clearance in septic shock patients with high bilirubin levels
title_short	Significance of lactate clearance in septic shock patients with high bilirubin levels
title_full	Significance of lactate clearance in septic shock patients with high bilirubin levels
title_fullStr	Significance of lactate clearance in septic shock patients with high bilirubin levels
title_full_unstemmed	Significance of lactate clearance in septic shock patients with high bilirubin levels
title_sort	significance of lactate clearance in septic shock patients with high bilirubin levels
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/7f98fea2fe824db2aace8bf0c8db4980
work_keys_str_mv	AT nozomitakahashi significanceoflactateclearanceinsepticshockpatientswithhighbilirubinlevels AT takaakinakada significanceoflactateclearanceinsepticshockpatientswithhighbilirubinlevels AT keithrwalley significanceoflactateclearanceinsepticshockpatientswithhighbilirubinlevels AT jamesarussell significanceoflactateclearanceinsepticshockpatientswithhighbilirubinlevels
_version_	1718393341752639488

Significance of lactate clearance in septic shock patients with high bilirubin levels

Ejemplares similares