Differential effect of lactate in predicting mortality in septic patients with or without disseminated intravascular coagulation: a multicenter, retrospective, observational study

Abstract Background We examined whether high lactate level in septic patients was associated with 90-day mortality based on the patients’ disseminated intravascular coagulation (DIC) status. Methods We conducted a multicenter, retrospective, observational study of patients admitted to the intensive...

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Main Authors: Daisuke Hasegawa, Kazuki Nishida, Yoshitaka Hara, Takahiro Kawaji, Kazuhiro Moriyama, Yasuyo Shimomura, Daisuke Niimi, Hidefumi Komura, Osamu Nishida
Format: Article
Language:English
Published: BMC 2019-06-01
Series:Journal of Intensive Care
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Online Access:http://link.springer.com/article/10.1186/s40560-019-0389-x
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Summary:Abstract Background We examined whether high lactate level in septic patients was associated with 90-day mortality based on the patients’ disseminated intravascular coagulation (DIC) status. Methods We conducted a multicenter, retrospective, observational study of patients admitted to the intensive care unit (ICU) with a suspicion of severe infection and diagnosed with sepsis. Regression analyses were performed to estimate the interaction effect between DIC status and the lactate level. Then, the association between the lactate level and 90-day mortality was assessed in the DIC and non-DIC subgroups. Results The data of 415 patients were analyzed. We found a significant interaction between DIC status and the lactate level for predicting 90-day mortality (p interaction = 0.04). Therefore, we performed a subgroup analysis and found that high lactate concentration was significantly associated with 90-day mortality in the DIC group (odds ratio = 2.31, p = 0.039) but not in the non-DIC group. Conclusions In patients with DIC, a high lactate level significantly predicted 90-day mortality; no such association was found in the non-DIC group. Thus, DIC status may serve as a possible effect modifier of lactate level in predicting mortality in patients with sepsis.
ISSN:2052-0492