Sepsis is associated with a high inpatient mortality rate. Many studies have confirmed the prognostic value of lactate levels: elevated initial lactate levels have been associated with mortality in sepsis patients, and early lactate clearance is associated with a better survival. As confirmed by recent studies, lactate normalization during resuscitation (which is one of the keys of the treatment of sepsis patients) is a powerful indicator of the suitableness of resus. The aim of this meta-analysis is to assess the effect of early lactate clearance-directed therapy as a potentially more adequate resuscitation target.
Pan et al. conducted a meta-analysis where they analysed the data gathered from multiple studies published from as far back as 1976 to February 2018. After the authors identified and excluded articles in which the titles and abstracts appeared to meet the inclusion criteria, 108 articles were considered to be potentially eligible for inclusion. Of these 108 articles, the authors analysed seven randomized controlled trials that included a total of 1301 cases.
The results of this study show that lactate is a better indicator of total body homeostasis than oxigen-derived factors.
This study also shows that lactate clearance is associated with a shorter Intensive Care Unit stay, shorter mechanical ventilation time, and lower SOFA score than continuous central venous oxygen saturation (ScvO2) guided therapy.
A lower lactate clearance rate indicates a high risk of mortality and organ dysfunction, and lactate clearance can be used as a measure of improvement in the severity of abdominal septic shock.
This article was written by Jianzhen Pan, Milin Peng, Chao Liao, Xia Hu, Aimin Wang, and Xiangmin Li and published by Medicine in January 2019
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