Lactate acid as a prognostic value in sepsis

Postgraduate Thesis uoadl:2750684 398 Read counter

Unit:
Κατεύθυνση Μονάδες Εντατικής Θεραπείας και Επείγουσα Νοσηλευτική
Library of the School of Health Sciences
Deposit date:
2018-04-26
Year:
2018
Author:
Alivanoglou Anastasia
Supervisors info:
Χρ. Μαρβάκη, Ομότιμη Καθηγήτρια, Τμήμα Νοσηλευτική, ΤΕΙ Αθήνας
Γ. Βασιλόπουλος, Επίκουρος Καθηγητής, Τμήμα Νοσηλευτική, ΤΕΙ Αθήνας
Γ. Τουλιά, Επίκουρη Καθηγήτρια, Τμήμα Νοσηλευτική, ΤΕΙ Αθήνας
Original Title:
Ο ρόλος του γαλακτικού οξέος στην σήψη
Languages:
Greek
Translated title:
Lactate acid as a prognostic value in sepsis
Summary:
Introduction
Lactate, a product of glucose metabolism, is rapidly produced when oxygen delivery to the cell is insufficient to meet its requirements. Blood lactate levels have been shown to adequately reflect the presence and persistence of tissue hypoxia in critically ill patients. In some clinical syndromes, like sepsis, the interpretation of increased lactate levels can be difficult. There is strong evidence that large amounts of lactate can be produced and released under aerobic conditions and that the pathogenesis of hyperlactatemia in septic states is complex. In patients with critical illness, increased blood lactate levels and persistence of hyperlactatemia have been associated with significant morbidity and mortality. The development of fast and reliable analysers enables clinicians to frequently measure blood lactate levels. These measurements could lead to important diagnostic and therapeutic interventions whether the classic sings of shock are present or absent.

Purpose
The purpose of this systematic review was to investigate lactic acid as a prognostic marker in sepsis.

Material method
A systematic review was carried out on various surveys on this subject. The criteria for incorporating the articles were as follows: they should have been published in validated scientific journals, the language of the articles being either Greek or English, the date of their writing being between 2010 and 2016, their key words are related to the subject of work and are randomized clinical studies, cohort studies, and retrospective studies.

Results
Studies that meet the criteria are four. Two of the studies are retrospective cohort studies and both are prospective observational cohort studies. The first study showed that lower lactate levels are associated with survival after 30 days. The second showed that the lactic acid value 6 hours after the onset of oxygen therapy was the most potent prognostic factor in a 28-day mortality predictor in patients with sepsis or septic shock. In the third study improved that lower lactate clearance 24-48 hours, after the onset of treatment, has been associated with increased morbidity. The fourth study showed that the best predictor of mortality at 28 days was the clearance of lactic acid in the H0-H24 period. The fifth study showed that the high concentration of lactic acid is directly related to high mortality in ICU while lactic acid clearance has limited utility to predict survival. Sixth research has shown that lactic acid clearance can predict mortality and organic dysfunction in septic patients. The seventh study showed that patients with low Scvo2 and high lactic acid had increased mortality rates at 28 days. In the eighth study, severe hyperglycaemia (> 10 mmol / L) was associated with extremely high mortality in ICU, especially when there was no lactic acid within 12 hours. In vitro research has shown that lactic acid levels greater than 4mmol / L are associated with increased mortality risk in patients with septic shock. In the tenth research it was shown that early high lactic acid in patients with septic shock had poor prognosis and 24-hour lactic acid levels and lactic acid clearance were markers of the assessment of the clinical therapeutic effect and prognosis of patients with septic shock. Eleventh research has shown that lactic acid clearance, although slow, is uniform and can be used alone or in combination with other parameters to monitor recovery. Finally, the twelfth research has shown that in boys with shock, the level of lactic acid increases as the severity of the disease increases and is related to prognosis, so it is a useful predictor of the severity and prognosis of neonatal shock.

Conclusions
Elevated lactic acid levels or low lactate clearance in the first 24-48 hours in patients with sepsis or septic shock are associated with increased morbidity and mortality in clinics and ICUs. Perhaps the measurement of lactic acid is a non-invasive parameter that helps guide the treatment of sepsis.
Main subject category:
Health Sciences
Keywords:
Lactate acid, Severe sepsis, Prognostic value, Mortality
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
76
Number of pages:
63
File:
File access is restricted only to the intranet of UoA.

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