H. Wang1, X. Chen1, D. Wu1 1Qilu Hospital Of Shandong University,Department Of Critical Care Medicine,Jinan, SHANDONG, China
Introduction: The mortality of septic shock among elderly people is very high, and the early detection of patients with high death risk is important. We aimed to determine the predictive value of early lactate area for mortality in elderly patients with septic shock.
Methods: A prospective study was conducted from January 2012 to December 2013 in the intensive care unit of a chineses hospital with 3000 beds. A total of 115 septic shock patients with age ≥65 years were included in the study. Serum lactate was measured every 6 hours, the lactate indicators, including early lactate area, were recorded.
Results: The overall 28-day mortality rate was 67.0%. The top three primary infection sources were lung, abdominal cavity and bloodstream. When compared to survivors, non-survivors had significantly elevated early lactate area and APACHE II score and lowered lactate clearance, they were significantly more likely to have undergone mechanical ventilation, renal replacement therapy and inotropic or vasopressor support for ≥ 3d, and more frequently displayed signs of cardiovascular, respiratory, and renal and hepatic dysfunction (all P < 0.05). Receiver Operating Characteristic curves indicated the lactate area score displayed a strong predictive power for 28 day mortality as indicated by an AUC of 0.758 (P < 0.01) and had significantly greater predictive power when compared to the initial lactate or lactate clearance (all P < 0.05).
Conclusion:In geriatric patients with septic shock, the early lactate area is a useful predictor for early death and showed better predictive value than other lactate indicators.