Valor del lactato sérico como factor pronóstico de mortalidad en pacientes con sepsis
Palabras clave:
sepsis, mortalidad, ácido láctico, biomarcadores, infección
Resumen
Introducción: el lactato sérico constituye uno de los biomarcadores más importantes en la sepsis.
Objetivos: determinar el valor del lactato y su vinculación con la mortalidad en los pacientes con sepsis de cualquier origen y compararlos secundariamente con otras escalas.
Metodología: se aplicó un diseño de casos (pacientes adultos con sepsis y óbito) y controles (pacientes adultos con sepsis vivos al alta) en Servicio de Clínica Médica, Servicio de Terapia Intensiva de Adultos y Departamento de Urgencias del Hospital Nacional (Itauguá, Paraguay) en los años 2015 a 2016.
Resultados: se incluyeron 101 pacientes, 34 óbitos (casos) y 67 vivos (controles). No hubo diferencias estadísticamente significativas en el sexo y la media de edad entre casos y controles. Los focos infecciosos más frecuentes fueron pulmonar y abdominal. El lactato elevado se halló en 70% de los casos y en 30% de los controles (OR 4,5 IC95% 1,8-11) (p <0,001).
Conclusiones: existe una asociación entre la concentración sérica de lactato al ingreso y la mortalidad hospitalaria en pacientes con sepsis, independientemente de la comorbilidad y la edad.
Citas
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5. Orati JA, Almeida P, Santos V, Ciorla G, Lobo SM. Serum C-reactive protein concentrations in early abdominal and pulmonary sepsis. Rev Bras Ter Intensiva. 2013 Mar; 25(1): 6-11.
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7. Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005; 45:524–8.
8. Thomas-Rueddel DO, Poidinger B, Weiss M, Bach F, Dey K, Häberle H, et al. Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock. J Crit Care. 2015 Apr; 30(2):439.e1-6.
9. Yoo JW, Lee JR, Jung YK, Choi SH, Son JS, Kang BJ, et al. A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock. Korean J Intern Med. 2015 Jul; 30(4):471-7.
10. American College of Chest Physicians, Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992; 20:864-74.
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14. Zanon F, Caovilla JJ, Schwerz Michel R, Vieira Cabeda E, Ceretta DF, Denardin Luckemeyer G, Beltrame C, Posenatto N. Sepse na unidade de terapia intensiva: etiologias, fatores prognósticos e mortalidade. Rev. bras. ter. Intensiva. 2008 abr.-jun; 20(2): 128-34.
15. Green JP, Berger T, Garg N, Shapiro NI. Serum lactate is a better predictor of short-term mortality when stratified by C-reactive protein in adult emergency department patients hospitalized for a suspected infection. Ann Emerg Med. 2011 Mar; 57(3):291-5.
16. Gaieski DF, Goyal M. Serum lactate as a predictor of mortality in emergency department patients with infection: does the lactate level tell the whole story?. Ann Emerg Med. 2005 Dec; 46(6):561-2.
17. Reed L, Carroll J, Cummings A, Markwell S, Wall J, Duong M. Serum lactate as a screening tool and predictor of outcome in pediatric patients presenting to the emergency department with suspected infection. Pediatr Emerg Care. 2013 Jul; 29(7):787-91.
18. Lee SW, Hong YS, Park DW, Choi SH, Moon SW, Park JS, Kim JY, Baek KJ. Lactic acidosis not hyperlactatemia as a predictor of in hospital mortality in septic emergency patients. Emerg Med J. 2008 Oct; 25(10):659-65.
19. Berger T, Green J, Horeczko T, Hagar Y, Garg N, Suarez A, Panacek E, Shapiro N. Shock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med. 2013 Mar; 14(2):168-74.
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21. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017 Mar; 43(3):304-77.
22. Oedorf K, Day DE, Lior Y, Novack V, Sanchez LD, Wolfe RE, Kirkegaard H, Shapiro NI, Henning DJ. Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection. West J Emerg Med. 2017 Feb;18(2):258-266.
23. Rebello A, Thabah MM, Dutta TK, Bobby Z, Harish BN, Mehalingam V. Procalcitonin levels in sepsis and its association with clinical outcome in southern India. Trop Doct. 2017 Jan 1:49475517702314.
24. Godinjak A, Iglica A, Rama A, Tančica I, Jusufović S, Ajanović A, Kukuljac A. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta Med Acad. 2016 Nov; 45(2):97-103.
25. Hu H, Du X, He Y, Yu C. Application of SOFA score as a predict tool for mortality of delayed admission to ICU on patients with acute respiratory failure. Am J Emerg Med. 2017 Feb 15. pii: S0735-6757(17)30122-5.
26. Fuller BM, Dellinger RP. Lactate as a hemodynamic marker in the critically ill. Curr Opin Crit Care. 2012 Jun;18(3):267-72.
27. Garcia-Alvarez M, Marik P, Bellomo R. Sepsis-associated hyperlactatemia. Crit Care. 2014 Sep 9;18(5):503.
28. Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care. 2006 Aug;12(4):315-21.
29. Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010 Sep 15;182(6):752-61.
30. ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014 May 1;370(18):1683-93
31. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):762-74.
32. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.
33. Rhee C, Klompas M. New Sepsis and Septic Shock Definitions: Clinical Implications and Controversies. Infect Dis Clin North Am. 2017 Jul 5. pii: S0891-5520(17)30031-4.
2. Palomba H, Corrêa TD, Silva E, Pardini A, Assuncao MS. Comparative analysis of survival between elderly and non-elderly severe sepsis and septic shock resuscitated patients. Einstein (Sao Paulo). 2015 Jul-Sep; 13(3): 357-63.
3. Londoño J, León AL, Rodríguez F, Barrera L, de la Rosa G, Dennis R, et al. Lactato sérico en urgencias como factor pronóstico en pacientes con sepsis sin hipotensión. Med Clin (Barc). 2013 Sep 21; 141(6): 246-51.
4. Ranzani OT, Monteiro MB, Ferreira EM, Santos SR, Machado FR, Noritomi DT. Reclassifying the spectrum of septic patients using lactate: severe sepsis, cryptic shock, vasoplegic shock and dysoxic shock. Rev Bras Ter Intensiva. 2013 Oct-Dec; 25(4): 270-8.
5. Orati JA, Almeida P, Santos V, Ciorla G, Lobo SM. Serum C-reactive protein concentrations in early abdominal and pulmonary sepsis. Rev Bras Ter Intensiva. 2013 Mar; 25(1): 6-11.
6. Moretti D, Ramírez MM, Settecase CJ, Bagilet DH, Quaglino MB. Valor de la procalcitonina al ingreso en terapia intensiva para el diagnóstico y el pronóstico de la sepsis. Med Intensiva. 2013 Apr; 37(3): 156-62.
7. Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005; 45:524–8.
8. Thomas-Rueddel DO, Poidinger B, Weiss M, Bach F, Dey K, Häberle H, et al. Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock. J Crit Care. 2015 Apr; 30(2):439.e1-6.
9. Yoo JW, Lee JR, Jung YK, Choi SH, Son JS, Kang BJ, et al. A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock. Korean J Intern Med. 2015 Jul; 30(4):471-7.
10. American College of Chest Physicians, Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992; 20:864-74.
11. Valeiro DF, Uchôa da Silva RS. Diagnóstico da síndrome da resposta inflamatória sistêmica e sepse. Rev Bras Clín Méd. 2012 jan-fev; 10(1):5-10.
12. Yoshihara JCh, Okamoto TY, Queiroz Cardozo LT, Dantas de Maio Carrilho CM, Moro Kauss IA, Carvalho LM, et al. Análise descritiva dos pacientes com sepse grave ou choque séptico e fatores de risco para mortalidade. Semina cienc. biol. saude. 2011 jul.-dez; 32(2): 127-34.
13. Liñán Ponce JY, Véliz Vilcapoma F. Características clínicas de los pacientes con sepsis severa admitidos a una Unidad de Cuidados Intensivos. Rev. Soc. Peru. Med. Interna. 2008 oct.-dic; 21(4): 139-42.
14. Zanon F, Caovilla JJ, Schwerz Michel R, Vieira Cabeda E, Ceretta DF, Denardin Luckemeyer G, Beltrame C, Posenatto N. Sepse na unidade de terapia intensiva: etiologias, fatores prognósticos e mortalidade. Rev. bras. ter. Intensiva. 2008 abr.-jun; 20(2): 128-34.
15. Green JP, Berger T, Garg N, Shapiro NI. Serum lactate is a better predictor of short-term mortality when stratified by C-reactive protein in adult emergency department patients hospitalized for a suspected infection. Ann Emerg Med. 2011 Mar; 57(3):291-5.
16. Gaieski DF, Goyal M. Serum lactate as a predictor of mortality in emergency department patients with infection: does the lactate level tell the whole story?. Ann Emerg Med. 2005 Dec; 46(6):561-2.
17. Reed L, Carroll J, Cummings A, Markwell S, Wall J, Duong M. Serum lactate as a screening tool and predictor of outcome in pediatric patients presenting to the emergency department with suspected infection. Pediatr Emerg Care. 2013 Jul; 29(7):787-91.
18. Lee SW, Hong YS, Park DW, Choi SH, Moon SW, Park JS, Kim JY, Baek KJ. Lactic acidosis not hyperlactatemia as a predictor of in hospital mortality in septic emergency patients. Emerg Med J. 2008 Oct; 25(10):659-65.
19. Berger T, Green J, Horeczko T, Hagar Y, Garg N, Suarez A, Panacek E, Shapiro N. Shock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med. 2013 Mar; 14(2):168-74.
20. Su CM, Cheng HH, Tsai TC, Hsiao SY, Tsai NW, Chang WN, et al. Elevated serum vascular cell adhesion molecule-1 is associated with septic encephalopathy in adult community-onset severe sepsis patients. Biomed Res Int. 2014; 2014:598762.
21. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017 Mar; 43(3):304-77.
22. Oedorf K, Day DE, Lior Y, Novack V, Sanchez LD, Wolfe RE, Kirkegaard H, Shapiro NI, Henning DJ. Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection. West J Emerg Med. 2017 Feb;18(2):258-266.
23. Rebello A, Thabah MM, Dutta TK, Bobby Z, Harish BN, Mehalingam V. Procalcitonin levels in sepsis and its association with clinical outcome in southern India. Trop Doct. 2017 Jan 1:49475517702314.
24. Godinjak A, Iglica A, Rama A, Tančica I, Jusufović S, Ajanović A, Kukuljac A. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta Med Acad. 2016 Nov; 45(2):97-103.
25. Hu H, Du X, He Y, Yu C. Application of SOFA score as a predict tool for mortality of delayed admission to ICU on patients with acute respiratory failure. Am J Emerg Med. 2017 Feb 15. pii: S0735-6757(17)30122-5.
26. Fuller BM, Dellinger RP. Lactate as a hemodynamic marker in the critically ill. Curr Opin Crit Care. 2012 Jun;18(3):267-72.
27. Garcia-Alvarez M, Marik P, Bellomo R. Sepsis-associated hyperlactatemia. Crit Care. 2014 Sep 9;18(5):503.
28. Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care. 2006 Aug;12(4):315-21.
29. Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010 Sep 15;182(6):752-61.
30. ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014 May 1;370(18):1683-93
31. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):762-74.
32. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.
33. Rhee C, Klompas M. New Sepsis and Septic Shock Definitions: Clinical Implications and Controversies. Infect Dis Clin North Am. 2017 Jul 5. pii: S0891-5520(17)30031-4.
