Association between lactate clearance rate and 28-day mortality in patients with sepsis: a retrospective cohort study and exploration of an optimal lactate clearance as an endpoint of resuscitation -
4 hours ago
- #lactate clearance
- #critical care
- #sepsis
- A retrospective cohort study analyzed sepsis patients from MIMIC-IV and eICU databases to examine the relationship between hourly lactate clearance rate (LCRperhour) and 28-day mortality.
- Higher LCRperhour was significantly associated with reduced 28-day mortality, with an odds ratio of 0.03 (95% CI: 0.01 to 0.09, P < 0.001).
- The adjusted restricted cubic spline model revealed a reverse J-shaped nonlinear relationship, with an inflection point at an LCRperhour of 0.11, indicating a plateau in survival benefit beyond this threshold.
- Patients with LCRperhour ≥ 0.11 had significantly lower mortality than those with LCRperhour < 0.11, regardless of whether initial lactate levels were high (>4 mmol·L⁻¹) or low (2-4 mmol·L⁻¹).
- The findings suggest that targeting a lactate clearance rate of ≥0.11 per hour could serve as an individualized endpoint for fluid resuscitation in sepsis management.