TY - JOUR
T1 - Serum lactate and mean arterial pressure thresholds in patients with cirrhosis and septic shock
AU - Smith, Thomas N.
AU - Choi, Chansong
AU - Rattan, Puru
AU - Serafim, Laura Piccolo
AU - Kassmeyer, Blake A.
AU - Lennon, Ryan J.
AU - Gajic, Ognjen
AU - Olson, Jody C.
AU - Kamath, Patrick S.
AU - De Moraes, Alice Gallo
AU - Simonetto, Douglas A.
N1 - Publisher Copyright:
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.
PY - 2024/1
Y1 - 2024/1
N2 - Background: The Sepsis-3 guidelines have incorporated serum lactate levels of > 2 mmol/L in septic shock definition to account for higher observed mortality. Further evidence is needed to support this threshold in cirrhosis, as well as target mean arterial pressure (MAP) during resuscitation. Methods: This observational cohort study investigated the association between initial serum lactate and resuscitation MAP levels on in-hospital mortality in patients with and without cirrhosis. Patients admitted to the intensive care unit for the treatment of septic shock between 2006 and 2021 in a quaternary academic center were included. Patients with cirrhosis documented on imaging and International Classification of Disease codes (n = 595) were compared to patients without cirrhosis (n = 575). The association of intensive care unit admission lactate levels and median 2-hour MAP with in-hospital mortality and the need for continuous renal replacement therapy was assessed. The association between median 24-hour MAP and in-hospital mortality was analyzed post hoc. Results: Within the cirrhosis group, admission lactate levels of 2-4 and > 4 mmol/L were associated with increased in-hospital mortality compared to lactate <2 mmol/L [adjusted odds ratio (aOR): 1.69, CI: 1.03-2.81, aOR: 4.02, CI: 2.53-6.52]. Median 24-hour MAP 60-65 and <60 mm Hg were also associated with increased in-hospital mortality compared with MAP > 65 mm Hg (aOR: 2.84, CI: 1.64-4.92 and aOR: 7.34, CI: 3.17-18.76). In the noncirrhosis group, associations with in-hospital mortality were weaker for lactate 2-4 and > 4 mmol/L (aOR: 1.32, CI: 0.77-2.27 and aOR: 2.25, CI: 1.40-3.67) and median 24-hour MAP 60-65 and <60 mm Hg (aOR: 1.70, CI: 0.65-4.14 and aOR: 4.41, CI: 0.79-29.38). Conclusions: These findings support utilizing lactate > 2 mmol/L in the definition of septic shock, as well as a target MAP of > 65 mm Hg during resuscitation in patients with cirrhosis.
AB - Background: The Sepsis-3 guidelines have incorporated serum lactate levels of > 2 mmol/L in septic shock definition to account for higher observed mortality. Further evidence is needed to support this threshold in cirrhosis, as well as target mean arterial pressure (MAP) during resuscitation. Methods: This observational cohort study investigated the association between initial serum lactate and resuscitation MAP levels on in-hospital mortality in patients with and without cirrhosis. Patients admitted to the intensive care unit for the treatment of septic shock between 2006 and 2021 in a quaternary academic center were included. Patients with cirrhosis documented on imaging and International Classification of Disease codes (n = 595) were compared to patients without cirrhosis (n = 575). The association of intensive care unit admission lactate levels and median 2-hour MAP with in-hospital mortality and the need for continuous renal replacement therapy was assessed. The association between median 24-hour MAP and in-hospital mortality was analyzed post hoc. Results: Within the cirrhosis group, admission lactate levels of 2-4 and > 4 mmol/L were associated with increased in-hospital mortality compared to lactate <2 mmol/L [adjusted odds ratio (aOR): 1.69, CI: 1.03-2.81, aOR: 4.02, CI: 2.53-6.52]. Median 24-hour MAP 60-65 and <60 mm Hg were also associated with increased in-hospital mortality compared with MAP > 65 mm Hg (aOR: 2.84, CI: 1.64-4.92 and aOR: 7.34, CI: 3.17-18.76). In the noncirrhosis group, associations with in-hospital mortality were weaker for lactate 2-4 and > 4 mmol/L (aOR: 1.32, CI: 0.77-2.27 and aOR: 2.25, CI: 1.40-3.67) and median 24-hour MAP 60-65 and <60 mm Hg (aOR: 1.70, CI: 0.65-4.14 and aOR: 4.41, CI: 0.79-29.38). Conclusions: These findings support utilizing lactate > 2 mmol/L in the definition of septic shock, as well as a target MAP of > 65 mm Hg during resuscitation in patients with cirrhosis.
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U2 - 10.1097/HC9.0000000000000353
DO - 10.1097/HC9.0000000000000353
M3 - Article
C2 - 38180993
AN - SCOPUS:85188338336
SN - 2471-254X
VL - 8
JO - Hepatology Communications
JF - Hepatology Communications
IS - 1
M1 - e0353
ER -