scholarly journals Lactate as a Predictor in Severe Pneumonia

2015 ◽  
Vol 15 (1) ◽  
pp. 29-34
Author(s):  
Darta Ose ◽  
Arvids Berzins ◽  
Krista Grigorovica ◽  
Andris Klucniks ◽  
Olegs Sabelnikovs
Keyword(s):  
Septic Shock ◽  
Blood Lactate ◽  
Mortality Risk ◽  
Lactate Level ◽  
Prognostic Significance ◽  
Severe Pneumonia ◽  
Serum Lactate ◽  
Community Acquired Pneumonia ◽  
University Hospital ◽  
Severe Community Acquired Pneumonia

Summary Introduction. There are many discussions that one of the mortality risk markers for patients admitted to intensive care unit (ICU) with different etiology shock is admission blood lactate level. It is believed that serum lactate could be used as an early marker of mortality risk determination. We are not aware about research studies regarding admission serum lactate prognostic significance in patients with severe community acquired pneumonia (CAP) in first 24 hours after admission to ICU in Latvia. Aim of the study. 1. To evaluate the prognostic significance of the first lactate level in patients with severe pneumonia. To compare the statistical data of different blood lactate levels (LAC1, LAC2, LAC3, LAC4, LACMAX, LACMIN). 2. To find admission lactate reference level which is attributed to significant increase of mortality. 3. To compare with other markers and scoring systems like: PCT (procalcitonin), CRP (C-reactive protein), CURB-65 (pneumonia severity score), APACHEII (Acute Physiology and Chronic Health Evaluation II). Material and methods. This is a retrospective observational study in which data were collected on all patients admitted to ICUwith pneumonia and sepsis and/or septic shock in two major Hospitals of Republic of Latvia (Eastern Clinical university hospital and Pauls Stradins Clinical university hospital) with primary diagnosis of severe community acquired pneumonia (CAP). We compared the relationship between lactate values that were collected in 24 hour period after admission in ICU and ICU mortality. Results. In this study we analyzed data from consecutive 73 patients with severe CAP and sepsis and/or septic shock and we observed statistically significant difference between the first lactate level (LAC1) in survivors (2.7 [1.9-3.2] (mmol/l) and non-survivors 4.9 [4.3-7.5] (mmol/l); p<0.001).According to data patients with LAC1<3.0 (mmol/l) mortality risk was 0%, patients with LAC1 3.0 - 4.0 (mmol/l) risk was 42.1%, while patients with LAC1>4.0 (mmol/l) mortality risk reached 89.7%. Lactate level measurements in first 24 hours after arrival into the ICU have had high ability to stratify non-survivor patients: LAC1 (0.96), LAC2 (0.98), LAC3 (0.97), LAC4 (0.92), (AUC). Incomparison with other prognostic markers sensitivity and specificity following results were obtained: CRP (0.59), PCT (0.98), APACHE II (0.98), CURB-65 (0.63). Conclusions. Summarizing data on patients with severe pneumonia and sepsis and/or septic shock admission lactate in first 24 hours have significant independent predictive value. In first 24 hours after admission in ICU higher mortality were observed if LAC1 was >3 (mmol/l). Data proves for the patients with severe pneumonia LAC1 is having similar prognostic ability like APACHEII and PCT, and significantly better prognostic ability than CRP and CURB-65.

scholarly journals A Study on Shock Index in Early Diagnosis of Sepsis in Emergency Department of Tertiary Care Centre of Nepal

2019 ◽  
Vol 2 (2) ◽  
pp. 37-42
Author(s):  
Manish Nath Pant ◽  
Subash Dawadi ◽  
Ashish Thapa
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Severe Sepsis ◽  
Early Diagnosis ◽  
Blood Lactate ◽  
Lactate Level ◽  
Tertiary Care ◽  
Serum Lactate ◽  
Shock Index ◽  
Tertiary Care Centre

Introduction: Sepsis and its consequences, severe sepsis and septic shock is at menace in country like ours where infectious disease are at toll. Early diagnosis and treatment is very important to decrease the morbidity and mortality. Shock index is one of such tool that is very handy in these situations as this is just a mathematical calculation using heart rate(HR) and systolic blood pressure(SBP). The main aim of this study was to find the effectiveness of using SI as an adjunct to blood lactate in diagnosing patients in sepsis. Methods: This was an observational hospital-based study conducted at Emergency Department of TUTH, Maharajgunj on 104 patients, obtained by purposive sampling method, who had presented to the “Red Area”, aged between 18 to 65 years. These patients were screened for severe sepsis using triage vital signs, basic laboratory tests and an initial serum lactate level. Test characteristics were calculated for hyperlactatemia. I considered the following covariates in our analysis: heart rate >90 beats/min; mean arterial pressure <65 mmHg; respiratory rate > 20 breaths/min; ≥2 SIRS including white blood cell count; SI <0.6; SI 0.6 to 1; SI 1 to 1.4and SI ≥ 1.4.  Results: There was a positive correlation between shock index and blood lactate level, r=0.2, n=104, p=0.042. No relationship was found between SI>=1 and hyperlactemia, X2 (.285, N = 104) = 1, p =.594 and relationship was found between SI >=0.7 and hyperlactemia, X2 (4.1, N = 104) = 1, p =.04. sensitivity and specificity for detecting hyperlactemia of SI>=1, SI.=0.7, SIRS was 84% and 20%, 93% and 0%, 79% and 20% respectively. Conclusions: There was weak correlation between the lactate level and shock index with statistically significant correlation between the shock index grouped >=0.7 and hyperlactatemia with high sensitivity and very low specificity.

scholarly journals Severe Community-Acquired Pneumonia due to Acinetobacter baumannii in North America: Case Report and Review of the Literature

2018 ◽  
Vol 5 (3) ◽  
Author(s):  
David P Serota ◽  
Mary Elizabeth Sexton ◽  
Colleen S Kraft ◽  
Federico Palacio
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Acute Respiratory Distress Syndrome ◽  
Case Report ◽  
North America ◽  
Acinetobacter Baumannii ◽  
Distress Syndrome ◽  
Community Acquired Pneumonia ◽  
Review Of The Literature ◽  
Severe Community Acquired Pneumonia

Abstract Acinetobacter baumannii is a rare but emerging cause of fulminant community-acquired pneumonia (CAP-AB). We describe a patient from a rural area who developed acute respiratory distress syndrome and septic shock. We describe risk factors and characteristics of this syndrome and review published cases of CAP-AB from North America.

scholarly journals Ampicillin & Gentamicin V/S 3rd Generation Cephalosporin for the Management of Community-Acquired Pneumonia in Children; A Comparative Analysis

2021 ◽  
pp. 29-35
Author(s):  
Aneel Kumar ◽  
Heena Rais ◽  
Arit Prakash ◽  
Amin Ali ◽  
Sandeep Jung ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Acquired Resistance ◽  
Generation Cephalosporin ◽  
Community Acquired Pneumonia ◽  
Careful Consideration ◽  
University Hospital ◽  
Disease Symptoms ◽  
Childhood Morbidity ◽  
The Mean ◽  
Severe Community Acquired Pneumonia

Background: Community acquired pneumonia (CAP) is a common cause of childhood morbidity, attributed to every 1 in 500 hospitalization of children under the age of 5 years. While science made therapeutic advancements to battle CAP, the pathogens too have acquired resistance to many drugs. In this fight for dominance, Ampicillin plus Gentamicin and 3rd Gen Cephalosporins are nowadays the cornerstone of treatment. However, their efficacy varies in different parts of the world owing to differing levels of drug resistance. Objective: To compare the effect of Ampicillin and Gentamicin vs. third generation cephalosporin in treatment of severe community acquired pneumonia. Methodology: This Randomized Controlled Trial was conducted at the Dept. of Pediatrics (Ziauddin University Hospital) upon a sample of 74 patients (in two equal groups) of either gender, aged 2 months to 5 years, presenting with CAP. After taking written informed consent, data was recorded onto a pre-structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, presenting complaints, immunization status of the pneumococcal and HIB vaccine, laboratory values, and treatment outcome. Results: The mean age of the sample stood at 15 months (SD ± 3) with a majority of the sample comprising of male children (52.7%). The mean weight stood at 8.7 kg (SD ± 0.9) and the mean height was recorded to be 74.2 cm (SD ± 11). The commonest symptoms included fever, fast breathing, chest in-drawing and added sounds. It was revealed that both treatments achieved successful treatment outcomes in all patients with no mortality. The resolution of symptoms however varied with faster resolution observed in the Cephalosporin group. Conclusion: After careful consideration, it can be concluded that 3rd generation cephalosporins is more efficacious at treatment of CAP with significantly faster resolution of disease symptoms.

scholarly journals The handheld blood lactate analyser versus the blood gas based analyser for measurement of serum lactate and its prognostic significance in severe sepsis

2016 ◽  
Vol 72 (4) ◽  
pp. 325-331 ◽  
Author(s):  
Shivinder Singh ◽  
Abhishek Bhardawaj ◽  
Ratnesh Shukla ◽  
Trimbak Jhadav ◽  
Anoop Sharma ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Blood Lactate ◽  
Prognostic Significance ◽  
Serum Lactate ◽  
Blood Gas

scholarly journals Serum Lactate –An indicator of morbidity and mortality in polytrauma and multi-trauma patients

2013 ◽  
Vol 2 (1) ◽  
pp. 7-13 ◽  
Author(s):  
P Lamichhane ◽  
S Shrestha ◽  
B Banskota ◽  
AK Banskota
Keyword(s):  
Multiple Trauma ◽  
Blood Lactate ◽  
Lactate Level ◽  
Life Support ◽  
Serum Lactate ◽  
Morbidity And Mortality ◽  
Trauma Patients ◽  
Serum Lactate Level ◽  
Lactate Levels ◽  
Elevated Lactate

Background: The search for the best marker or set of markers for the diagnosis, prognosis and treatment of ‘at risk’ trauma patients is ongoing. Serial estimation of serum lactate values are thought to help predict morbidity and mortality in trauma victims. There is evidence to support the use of blood lactate levels as an end point of resuscitation. The presence of elevated lactic acid levels in the serum can direct the treating physician to safe and correct timing of any surgical intervention. Early identification and aggressive resuscitation measures aimed at correcting the impaired metabolic dysfunction improves survival and reduces complications in severely injured trauma patients. Methods: A prospective analytical study of 52 patients with polytrauma and multiple trauma admitted within 12 hours of injury to our institution between March 2007 to February 2008 was carried out. All the patients were resuscitated as per the advance trauma life support (ATLS) protocol in the emergency room. Serum lactate level was analyzed on the 1st, 5th and 14th day of injury. Serum lactate levels greater than 2 milimoles/L was considered abnormal and serum lactate level greater than 5 milimoles/L was considered significant. Results: There were 45 males and 7 females with an average age of 32.8 years (18-82). 18 patients out of 52 sustained polytrauma. Of these 18 patients, 8 patients sustained chest injury, 4 had head injury and 2 had abdominal injury. In the polytrauma group (n-18), 5 patients had an elevated lactate above 2 milimoles/Lon admission. 2 patients who had significant rise of lactate (>5 milimoles/L) on admission died on the 5th day. Out of 34 multiple trauma patients, 13 patients had an elevated lactate level at admission. One patient in this group with lactate level 7.2 died of ARDS on 3rd day of admission. Conclusion: Blood lactate appears to be a reliable marker reflecting not only the severity of the shock, but also for predicting survival. The longer the lactate is elevated, the more a patient is likely to develop multiple organ dysfunctions and die. Lactate levels followed over time is more reliable than isolated values. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8134 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 7-13

Initial serum lactate level is associated with inpatient mortality in patients with community-acquired pneumonia

2015 ◽  
Vol 33 (5) ◽  
pp. 685-690 ◽  
Author(s):  
Min Hyuk Gwak ◽  
Sion Jo ◽  
Taeoh Jeong ◽  
Jae Baek Lee ◽  
Young Ho Jin ◽  
...  
Keyword(s):  
Lactate Level ◽  
Serum Lactate ◽  
Community Acquired Pneumonia ◽  
Serum Lactate Level ◽  
Inpatient Mortality

scholarly journals Serum Lactate Level as a Predictor of Outcome in Patients with Septic Shock

2019 ◽  
Vol 2 (1) ◽  
pp. 43-51
Author(s):  
Rupak Bhandari ◽  
R Bhandari ◽  
M Paudel ◽  
G B Malla
Keyword(s):  
Septic Shock ◽  
Lactate Level ◽  
Multivariate Regression Analysis ◽  
Serum Lactate ◽  
High Morbidity ◽  
Serum Lactate Level ◽  
Cross Sectional ◽  
Female Ratio ◽  
Co Morbidity ◽  
Lactate Levels

Background: Sepsis and Septic shock are a common presentation in the Emergency Department with high morbidity and mortality. Serum lactate level increases substantially in the patients with septic shock. The objectives of this study were to determine serum lactate levels at the time of presentation, find out the outcome and correlate lactate levels with the outcome in the patients with septic shock. Methods: It is a prospective cross-sectional study of patients presenting to the Emergency, who met the criteria for septic shock defined by Surviving Sepsis Guidelines 2012. Patients’ demographics, co morbidity, triage vitals, laboratory and radiological parameters were recorded. The primary outcome was mortality and secondary outcomes were duration of stay in hospital and complications, if any, developed during hospital stay. Results: Eighty-four cases were enrolled, with male to female ratio of 1:1. Mean age was46.40 19.59 years. The significant variables were: serum lactate (p<0.001), pH level (p= 0.001), serum creatinine (p= 0.002) and INR level (p= 0.001). Serum lactate was the significant factor that correlated with mortality after applying multivariate regression analysis (OR= 2.75, CI= 0.890- 4.041,p= 0.001). Conclusion: Initial serum lactate level is independently associated with mortality of the patients presenting to ED with septic shock.

scholarly journals A Hypothesis-Generating Study of the Combination of Aspirin plus Macrolides in Patients with Severe Community-Acquired Pneumonia

2018 ◽  
Vol 63 (2) ◽  
pp. e01556-18 ◽  
Author(s):  
Marco Falcone ◽  
Alessandro Russo ◽  
Yuichiro Shindo ◽  
Alessio Farcomeni ◽  
Filippo Pieralli ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Survival Rates ◽  
Severe Pneumonia ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Teaching Hospitals ◽  
Score Analysis ◽  
Severe Community Acquired Pneumonia ◽  
Japan And China

ABSTRACT While the inflammatory response to severe pneumonia is paramount in limiting and resolving the infection, excessive inflammation can lead to deleterious effects. We theorized that patients with severe community-acquired pneumonia (CAP) who were treated with macrolides and aspirin would receive benefit beyond that of conventional antibiotic therapy. An observational study was conducted with patients with severe CAP. All patients were admitted to 5 teaching hospitals (in Italy, the United States, Japan, and China), and data were gathered from their electronic medical records. Severe pneumonia was defined according to Infectious Diseases Society of America/American Thoracic Society criteria. Patients were divided into 4 groups, i.e., (i) the aspirin-only group (ASG), (ii) the macrolide-only group (MG), (iii) the aspirin plus macrolide group (ASMG), or (iv) the neither aspirin nor macrolide group (NASMG). Survival rates for the 4 groups were evaluated after adjustment for confounders and after weighting by propensity score. A total of 1,295 patients were included in the analysis. There were 237 patients (18.3%) in the ASG, 294 (22.7%) in the MG, 148 (11.4%) in the ASMG, and 616 (47.6%) in the NASMG. The mortality rate at 30 days was 15.5% in the ASMG, compared to 28.2% in the NASMG, 23.8% in the MG, and 21.1% in the ASG. After propensity score analysis, receipt of aspirin plus macrolide (hazard ratio, 0.71 [95% confidence interval, 0.58 to 0.88]; P = 0.002) was associated with a higher 30-day survival rate. This is a hypothesis-generating study in which data suggest that the combination of aspirin plus a macrolide improves 30-day survival rates for patients with severe CAP. Further randomized studies will need to be undertaken to confirm this phenomenon.

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