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VOLUME 13 , ISSUE 2 ( June, 2009 ) > List of Articles


An evaluation of serial blood lactate measurement as an early predictor of shock and its outcome in patients of trauma or sepsis

Uma Krishna, Suresh P. Joshi, Mukesh Modh

Keywords : Outcome, sepsis, serial lactate values, shock, trauma

Citation Information : Krishna U, Joshi SP, Modh M. An evaluation of serial blood lactate measurement as an early predictor of shock and its outcome in patients of trauma or sepsis. Indian J Crit Care Med 2009; 13 (2):66-73.

DOI: 10.4103/0972-5229.56051

License: CC BY-ND 3.0

Published Online: 01-07-2012

Copyright Statement:  Copyright © 2009; The Author(s).


Context: Attainment of hemodynamic parameters to within a normal range may leave patients in compensatory shock. In such patients, serial blood lactate evaluation can be useful in predicting shock. Aims: To ascertain the role of serum lactate as a predictor of shock and its outcome in patients of trauma and sepsis. Settings and Design: A prospective, non-interventional study. Materials and Methods: The study included 50 patients (5 to 60 years old) of trauma admitted within 12 hours of injury and patients of suspected or proven sepsis. Those with chronic medical illnesses, alcohol intoxication, or poisoning were excluded. Blood lactate levels were analyzed at admission and 12, 24, and 36 hours of inclusion with records of corresponding hemodynamic variables, investigations, and interventions. The outcome was recorded as survival or non-survival. Statistical Analysis Used: Statistical analysis was done with a student′s t test and repeated measure ANOVA (Analysis of Variance). Results: An analysis revealed higher mean lactate levels in non-survivors as compared with survivors. Mean lactate levels in non-survivors did not attain normal levels, while that of survivors reached normal levels by 24 hrs in trauma patients and 36 hrs in sepsis patients. The predicted mortality rates by a lactate level >40 mg/dl at admission, 12, 24, and 36 hours were 52.6%, 61.5%, 83.3%, and 100%, respectively for both the subgroups combined. Non-survivors had a higher incidence of MODS (Multi Organ Dysfunction Syndrome). Conclusions: Serial lactate values followed over a period of time can be used to predict impending complications or grave outcome in patients of trauma or sepsis. Interventions that decrease lactate values to normal early may improve chances of survival and can be considered effective therapy. Lactate values need to be followed for a longer period of time in critical patients.

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  1. Dysoxia and Lactate. Arch Dis Child 1999;81:343-50.
  2. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
  3. Serum lactate, not base deficit, rapidly predicts survival after major burns. Burns 2002;28:161-6.
  4. Clin Chem 1989;35:1992-4.
  5. Natural history and course of acquired lactic acidosis in adults. The DCA-Lactic Acidosis Study Group Am J Med 1994;97:47-54.
  6. Increased Blood Lactate levels: An Important Warning Signal in Surgical Practice. Crit Care 2004;8:96-8.
  7. The Serial Estimation of Serum Lactate, Pyruvate and Base Deficit in Trauma Patients with Hypovolemic Shock: Indicator of Adequate Resuscitation and Management. Indian Journal of Anesthesia 2004;48:138-41.
  8. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care 2004;8:R60-R65.
  9. In Search of the Optimal End Points of Resuscitation in Trauma Patients: a review. J Trauma 1998;44:908-14.
  10. Multiorgan Failure: By The Time You Predict It, Its Already There. J Trauma 1999;46:597-606.
  11. Serial lactate determinations during circulatory shock. Crit Care Med 1983;11:449-51.
  12. Lactate clearance and survival following injury. J Trauma 1993;35:584-8; discussion 588-9.
  13. J. Hogan, W.C. Chiu, and T.M. Scalea. Outcome of trauma patients with elevated admission serum lactate and minimal injury. The American Association for the Surgery of Trauma, 2003
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