Lactate Clearance According to the Presence of Hepatic Dysfunction

Study Description

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

The purpose of this study is to compare lactate clearance in patients with severe sepsis and septic shock according to the presence of hepatic dysfunction.

Condition or disease
Sepsis; Liver Failure

Detailed Description:

Lactate clearance is well known to be associated with mortality in patients with severe sepsis and septic shock. To normalize lactate levels is one of important goals of early resuscitation of sepsis patients.

Lactate clearance can be changed by various factors including patient characteristics, severity of shock, and treatment. In particular, hepatic dysfunction might impair the clearance of lactate because liver is a principal organ for lactate metabolism. However, an association between lactate clearance and hepatic failure has not been evaluated during initial resuscitation of patients with severe sepsis and septic shock. The primary goal of this study is to compare lactate clearance in patients with severe sepsis and septic shock according to the presence of hepatic dysfunction. The secondary goal is to evaluate if lactate clearance is associated with mortality even in patients with hepatic dysfunction.

Study Design

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Study Type :	Observational
Estimated Enrollment :	245 participants
Observational Model:	Cohort
Time Perspective:	Prospective
Official Title:	Lactate Clearance and Mortality in Patients With Severe Sepsis and Septic Shock: Comparison by Hepatic Dysfunction
Study Start Date :	July 2012
Estimated Primary Completion Date :	June 2014
Estimated Study Completion Date :	June 2014

Groups and Cohorts

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Group/Cohort
No hepatic dysfunction; No hepatic dysfunction, total plasma bilirubin ≤ 2.0 mg/dl
Hepatic dysfunction; Hepatic dysfunction, total plasma bilirubin > 2.0 mg/dl

Outcome Measures

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Primary Outcome Measures :

1. Lactate clearance [ Time Frame: at 6-hour from the time of enrollment ]
   [(initial lactate − delayed lactate)/ initial lactate] *100%

Secondary Outcome Measures :

1. In-hospital mortality [ Time Frame: within the first 28-day after emergency department arrival ]

Biospecimen Retention:   Samples Without DNA

Interleukin-1, Interleukin-6, Interleukin-10, TNF-alfa

Eligibility Criteria

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	20 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No
Sampling Method:	Probability Sample

Study Population

Patients presenting to the emergency department and meeting criteria for severe sepsis or septic shock at Samsung Medical Center (a 1,960 bed, university-affiliated, tertiary referral hospital in Seoul, South Korea)

Criteria

Inclusion Criteria:

• Patients who presented with septic shock or severe sepsis within 6 hours after emergency department arrival

Exclusion Criteria:

• Terminal malignancy or illness with a expected survival < 4 months
• Patients who previously signed "Do Not Resuscitate" or "Do Not Intubate" orders
• Patients who do not undergo the early goal-directed therapy

Contacts and Locations

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Contacts

Contact: Ik Joon Jo, PhD	+82-2-3410-2053	drjij@skku.edu

Locations

Korea, Republic of
Samsung Medical Center, Sungkyunkwan University School of Medicine	Recruiting
Seoul, Korea, Republic of, 135-710

Sponsors and Collaborators

Samsung Medical Center

Investigators

Principal Investigator:	Ik Joon Jo, PhD	Samsung Medical Center

More Information

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Publications:

Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, Tomlanovich MC. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004 Aug;32(8):1637-42.

Levraut J, Ciebiera JP, Chave S, Rabary O, Jambou P, Carles M, Grimaud D. Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction. Am J Respir Crit Care Med. 1998 Apr;157(4 Pt 1):1021-6.

De Jonghe B, Cheval C, Misset B, Timsit JF, Garrouste M, Montuclard L, Carlet J. Relationship between blood lactate and early hepatic dysfunction in acute circulatory failure. J Crit Care. 1999 Mar;14(1):7-11.

Revelly JP, Tappy L, Martinez A, Bollmann M, Cayeux MC, Berger MM, Chioléro RL. Lactate and glucose metabolism in severe sepsis and cardiogenic shock. Crit Care Med. 2005 Oct;33(10):2235-40.

Kang YR, Um SW, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Jeon K. Initial lactate level and mortality in septic shock patients with hepatic dysfunction. Anaesth Intensive Care. 2011 Sep;39(5):862-7.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77.

Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA; Emergency Medicine Shock Research Network (EMShockNet) Investigators. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010 Feb 24;303(8):739-46. doi: 10.1001/jama.2010.158.

Responsible Party:	Jo, Ik Joon, Associate Professor, Samsung Medical Center
ClinicalTrials.gov Identifier:	NCT01709565 History of Changes
Other Study ID Numbers:	SamsungMC
First Posted:	October 18, 2012
Last Update Posted:	October 18, 2012
Last Verified:	October 2012

Keywords provided by Jo, Ik Joon, Samsung Medical Center:

Sepsis; Lactic acid; Shock; Resuscitation

Additional relevant MeSH terms:

Sepsis; Liver Failure; Infection; Systemic Inflammatory Response Syndrome; Inflammation	Pathologic Processes; Hepatic Insufficiency; Liver Diseases; Digestive System Diseases