The Effect of Lactate and Lactate Clearance on Mortality in Sepsis Patients Admitted to the Emergency Department

Öz

Objective Early prognosis of sepsis, which affects millions of people all over the world every year and can have a mortality of more than 25%, is very important especially for emergency services where patients spend their most critical golden hours. Lactate and lactate clearance are also potential marker candidates that can be used to predict mortality, which has now started to take place in sepsis guidelines. The aim of this study is to investigate the power of lactate and lactate clearance to predict mortality in sepsis. Material and Method All patients over the age of 18 with a diagnosis of severe sepsis and septic shock who presented to the emergency department during a one-year period were included in this prospective observational cohort study. The lactate clearance was calculated by taking the blood gases of the patients at the time of admission and six hours later, and evaluated in terms of predicting mortality along with other parameters. Results The decrease in lactate values at the sixth hour of 90 patients included in the study was found to be statistically significant (p=0.001). A positive and significant correlation was found between the lactate values of the patients at admission and mortality (p=0.046). A negative significant correlation was found between lactate clearance of the patients and mortality (p=0.001). Conclusion In patients with sepsis, the lactate value is important in determining mortality and prognosis. Regardless of arrival lactate value, the high rate of lactate reduction at the sixth hour indicates a good prognosis. In addition, it was determined that the sixth hour lactate value also had an effect on predicting mortality. When all these results are taken into consideration, it can be said that the lactate value and lactate clearance are useful predictors of prognosis in sepsis patients admitted to the emergency department. However, they are not sufficient on their own to determine the prognosis and should be used together with other markers and clinical evaluation.

Anahtar Kelimeler

• emergency room
• lactate
• lactate clearance
• sepsis

Acil Servise Başvuran Sepsis Hastalarında Laktat ve Laktat Klirensinin Mortaliteye Etkisi

Öz

Amaç Her yıl tüm dünyada milyonlarca insanı etkileyen ve mortalitesi %25’ten fazla olabilen sepsisin erken dönemde prognoz tayini özellikle hastaların en kritik altın saatlerini geçirdikleri acil servisler için çok önemlidir. Laktat ve laktat klirensi de artık sepsis kılavuzlarında yerini almaya başlamış mortalite öngörmede kullanılabilecek potansiyel belirteç adaylarındandırlar. Bu çalışmanın amacı laktat ve laktat klirensinin sepsiste mortaliteyi öngörme gücünün araştırılmasıdır. Gereç ve Yöntem Bu prospektif gözlemsel kohort çalışmasına bir yıllık dönemde acil servise başvuran 18 yaş üzeri tüm ağır sepsis ve septik şok tanılı hastalar dâhil edilmiştir. Hastaların başvuru sırasında ve altı saat sonra kan gazı alınarak laktat klirensi hesaplanmış ve diğer parametreler ile birlikte mortaliteyi öngörme açısından değerlendirilmiştir. Bulgular Çalışmaya alınan 90 hastanın altıncı saatteki laktat değerlerindeki düşme istatistiksel olarak anlamlı bulunmuştur (p=0.001). Hastaların başvurudaki laktat değerleri ile mortalite arasında pozitif yönde anlamlı ilişki saptanmıştır (p=0.046). Hastaların laktat klirensleri ile mortalite arasında negatif yönde anlamlı ilişki saptanmıştır (p=0.001). Sonuç Sepsis hastalarında geliş laktat değerinin mortalite ve prognozu belirlemede önemi vardır. Geliş laktat değerinden bağımsız olarak altıncı saatte laktatın düşme oranının yüksekliği iyi prognozu gösterir. Ayrıca altıncı saat laktat değerinin de mortaliteyi öngörmede etkisi olduğu belirlenmiştir. Tüm bu sonuçlar göze alındığında geliş laktat değerinin ve laktat klirensinin acil servise gelen sepsis hastalarında prognozu göstermede yararlı belirteçler olduğu söylenebilir. Ancak prognozu belirlemede tek başlarına yeterli değildirler, diğer belirteçler ve klinik değerlendirme ile beraber kullanılmalıdırlar.

Anahtar Kelimeler

• acil servis
• laktat
• laktat klirensi
• sepsis

Kaynakça

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