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Title: Mortality is greater in septic patients with hyperlactatemia than with refractory hypotension
Austin Authors: Gotmaker, Robert;Peake, Sandra L;Forbes, Andrew;Bellomo, Rinaldo ;ARISE Investigators
Affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
The University of Adelaide and The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
Australian and New Zealand Intensive Care Research Centre, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 28-Feb-2017 2017-02-28
Publication information: Shock 2017; online first: 28 February
Abstract: BACKGROUND: In septic patients, it is uncertain whether isolated hyperlactatemia (lactate ≥ 4 mmol/L without refractory hypotension) can be used to diagnose septic shock and whether mortality rate differs from that of isolated refractory hypotension (refractory to 1000 ml or greater fluid bolus). AIMS: To compare baseline characteristics, treatments and outcomes of participants enrolled into the Australian Resuscitation in Sepsis Evaluation (ARISE) trial according to the presence of isolated hyperlactatemia or isolated refractory hypotension. PATIENTS: Cohort of 1332 ARISE participants with sepsis and either isolated hyperlactatemia or isolated refractory hypotension. METHODS: We performed a secondary analysis of the ARISE data, constructing a propensity score model to discriminate between hyperlactatemia and isolated refractory hypotension. We analyzed 90-day all-cause mortality using a generalized linear model and inverse propensity score weighting. We modelled length of ICU and hospital stay using time to event analyses incorporating mortality as a competing risk. RESULTS: There were 478 participants (35.9%) with isolated hyperlactatemia and 854 (64.1%) with isolated refractory hypotension. They had similar median (interquartile range) ages (66.2 [54.2, 76.3] years versus 65.2 [50.9, 75.5] years) and similar sources of infection. However, isolated hyperlactatemia participants had higher mean (standard deviation) baseline APACHE II scores (isolated hyperlactatemia 16.2 [6.4]) versus 14.5 [6.4] for isolated refractory hypotension; p < 0.001). Isolated hyperlactatemia participants had a 1.7 times higher risk of 90-day mortality (propensity-weighted risk ratio; 95% confidence intervals [CI] 1.2, 2.5, P = 0.003). They were less likely to be discharged alive from ICU and hospital (propensity weighted sub-hazard ratio 0.77 (95%CI 0.64, 0.92; P < 0.005) and 0.79 (95% CI 0.66, 0.95; P = 0.01), respectively). CONCLUSIONS: ARISE trial participants with isolated hyperlactatemia had worse adjusted 90-day mortality than those with isolated refractory hypotension. In septic patients, isolated hyperlactatemia may define greater illness severity and worse outcomes than isolated refractory hypotension.
DOI: 10.1097/SHK.0000000000000861
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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