The Use of Laboratory and Physiological Parameters in Predicting Mortality in Sepsis Induced Hypotension and Septic Shock Patients attending The Emergency Department
- Author:
N A R Nik Hisamuddin
;
K Azlan
- Publication Type:Journal Article
- Keywords:
Sepsis, Septicemic Shock, Serum Lactate, Leucocyte Count
- From:
The Medical Journal of Malaysia
2012;67(3):259-264
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: In this study, we sought to determine whether
laboratory and physiological parameters can be useful in
predicting mortality in patients with sepsis-induced
hypotension and septic shock.
Methodology: This prospective cohort study was carried out
in the emergency department at an academic medical center.
A total of 51 patients met enrollment criteria during the
study period and 41 of them were included in the study.
Inclusion criteria were patients 18 years old or older,
diagnosed to have either sepsis-induced hypotension or
septic shock and investigated sepsis marker (blood lactate
and leukocytes) measured. Other physiological variables
were also measured in this study. The main outcome measure
was 30-day mortality. Kaplan-Meier, Log-rank and Cox's
methods were used for statistical analysis using SPSS version 12.0.1.
Results: 61% were diagnosed to have sepsis-induced
hypotension and 39% were diagnosed with septic shock.
Twenty two (54%) deaths occurred within the 30 day follow
up. The overall mean blood lactate level and leukocyte
counts were 3.52 mmol/L (SD=2.29) and 11.37 x 109 (SD=6.38)
respectively. A Cox Proportional Hazard Analysis revealed an increase in blood lactate levels in the ED was associated with an increased risk of death (B=0.35, HR=1.45, 95% CI 1.22,1.73, p<0.001). However no significant correlation between
the physiological parameters and the 30-day mortality.
Patients with septic shock state prior to initial presentation has a lower 30 day survival compared to any other septic conditions.
Conclusion: Our results support blood lactate level as a
promising risk stratification tool when compared with
leukocytes counts and other physiological parameters. The
multivariate analysis showed that for every increment of
lactate value of 1 mmol/L, the hazards of dying are expected to increase by 1.5 times (p<0.001).