BMC infectious diseases · 2025
Capillary lactate as a prognostic marker in sepsis: correlation with venous lactate and prediction of outcomes.
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Joseph Philip A, Doluweera Dinul, Chandraratne Amalka, Balasubramaniam Branavan, Abeyratne Varuna, Hewa Saman P, Rambukwella Roshan, Wanigasuriya Kamani P, Indrakumar Jegarajah, Perera Nilanka
Аннотация
INTRODUCTION: Venous lactate (VL) measured by a blood‒gas analyser is not widely available despite its importance in the management of sepsis. Capillary lactate (CL) measured via a hand-held lactate analyser is a feasible and less expensive option. The aim of this study was to determine the correlation between CL and VL in sepsis patients at 0 h (t0) and 6 h (t6) and identify the best CL and lactate clearance cut-off values that predicts a poor outcome.
METHODS: A descriptive study was conducted recruiting all patients with suspected sepsis (qSOFA ≥ 2 with evidence of infection) admitted to a tertiary care hospital in Sri Lanka between March and June 2022. "Lactate-plus", a hand-held lactate analyser, was used to measure CL and VL at t0 and t6 of admission. The lactate analyser was tested for accuracy and calibrated in a pilot study of 30 patients by correlating to laboratory lactate values. Patient demographics, clinical data and outcomes during hospitalization and at 28 days were assessed.
RESULTS: There were 102 patients with suspected sepsis and a median age of 71.5 (interquartile range: 62-77) years were recruited. Majority were females (n = 52, 51%). Majority of the source of infection was pulmonary (n = 57, 55.9%) and urological (n = 19, 18.6%). Paired CL and VL values significantly correlated at both t0 and t6 (p < 0.001). CL at t0 predicted 28-day mortality with a ROC curve AUC of 0.89 (95% CI: 0.82-0.95, p < 0.05) and 3.5 mmol/L was the best cut-off value with an 85% sensitivity and 78% specificity. CL ≥ 3.5 at t0 was associated with increased intensive care unit (ICU) admission (p < 0.01), vasopressor requirement (p < 0.0001), and a higher mortality rate (p < 0.001) compared to CL < 3.5. Additionally, a capillary lactate clearance greater than 64% predicted a good outcome, with a 97% sensitivity and 91% specificity.
CONCLUSIONS: CL measured by a lactate meter correlates well with VL and effectively predicts sepsis outcomes. A CL cut-off ≥ 3.5 mmol/L at admission increases the risk of mortality, vasopressor requirement and ICU admission, making CL a useful tool for risk assessment in sepsis.
METHODS: A descriptive study was conducted recruiting all patients with suspected sepsis (qSOFA ≥ 2 with evidence of infection) admitted to a tertiary care hospital in Sri Lanka between March and June 2022. "Lactate-plus", a hand-held lactate analyser, was used to measure CL and VL at t0 and t6 of admission. The lactate analyser was tested for accuracy and calibrated in a pilot study of 30 patients by correlating to laboratory lactate values. Patient demographics, clinical data and outcomes during hospitalization and at 28 days were assessed.
RESULTS: There were 102 patients with suspected sepsis and a median age of 71.5 (interquartile range: 62-77) years were recruited. Majority were females (n = 52, 51%). Majority of the source of infection was pulmonary (n = 57, 55.9%) and urological (n = 19, 18.6%). Paired CL and VL values significantly correlated at both t0 and t6 (p < 0.001). CL at t0 predicted 28-day mortality with a ROC curve AUC of 0.89 (95% CI: 0.82-0.95, p < 0.05) and 3.5 mmol/L was the best cut-off value with an 85% sensitivity and 78% specificity. CL ≥ 3.5 at t0 was associated with increased intensive care unit (ICU) admission (p < 0.01), vasopressor requirement (p < 0.0001), and a higher mortality rate (p < 0.001) compared to CL < 3.5. Additionally, a capillary lactate clearance greater than 64% predicted a good outcome, with a 97% sensitivity and 91% specificity.
CONCLUSIONS: CL measured by a lactate meter correlates well with VL and effectively predicts sepsis outcomes. A CL cut-off ≥ 3.5 mmol/L at admission increases the risk of mortality, vasopressor requirement and ICU admission, making CL a useful tool for risk assessment in sepsis.