New publication: In septic patients, initial lactate clearance is highly confounded by comorbidities and poorly predicts subsequent lactate trajectory
Now online: a Research Letter in Chest on the topic of lactate clearance in sepsis, led by medical student Reid McCallister and Rishi Chanderraj. This was a collaboration with Mike Sjoding and Mark Nuppnau.
In sepsis, we give a lot of weight to “lactate clearance” - whether or not we’re able to decrease a patient’s blood lactate level with resuscitation. It is recommended in Surviving Sepsis guidelines (“…we suggest guiding resuscitation to decrease serum lactate in patients with elevated lactate level, over not using serum lactate”) and has been used both as an enrollment criterion and a physiological endpoint in clinical trials. But lactate is a highly limited index of perfusion and response to resuscitation, and is quite confounded by comorbidities (like liver and kidney injury).
Using clinical data from 4,775 patients (with sepsis, an elevated lactate, and at least two lactate measurements), we asked if initial lactate clearance predicts 1) subsequent lactate trajectories and 2) patient prognosis. We found that the answer to #1 is “no, not well” and the answer the #2 is “not nearly as well as the confounding comorbidities.” Much of the prognostic utility of “failure to clear lactate” is actually due to confounding by liver failure.
This is Reid’s first first-author publication, and Rishi’s first senior-author publication. Congrats to both!
Reid McCallister
Rishi Chanderraj MD MS