Venous Lactate in Progression to Overt Septic Shock and Mortality in Non-elderly Sepsis Patients in Emergency Department
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Purpose
To investigate the role of initial venous lactate in predicting the severity progression to overt septic shock and 30-day mortality in non-elderly patients without hemodynamic shock who suspected to have acute infections.
| Condition |
|---|
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Sepsis Disease Progression Septic Shock Fatal Outcome |
| Study Type: | Observational [Patient Registry] |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Target Follow-Up Duration: | 1 Month |
| Official Title: | Can Venous Lactate Predict the Progression to Overt Septic Shock and Mortality in Non-elderly Sepsis Patients Without Hemodynamic Shock in Emergency Department? |
- Proportion of the patients who require vasopressor/mechanical ventilator [ Time Frame: 72 hours after venous lactate measurement ] [ Designated as safety issue: No ]Proportion of the patients in each cohort who require vasopressor/mechanical ventilator to maintain their vital signs in the next 72 hours after venous lactate measurement.
- All-cause mortality rates [ Time Frame: 30 days after the day of presentation to the emergency department ] [ Designated as safety issue: No ]Electronic database retrieval of in- and outpatient clinical records together with telephone follow-ups to the patients or their contact personnel are employed to every case in the next 30 days after the day of presentation to the emergency department to identify the deceased cases. All-cause mortality rates of each cohort will be compared by the survival analysis.
- Hospital length of stay [ Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 7 days ] [ Designated as safety issue: No ]Numbers of days spent in the hospital since the emergency department arrival to hospital discharge
Biospecimen Retention: Samples Without DNA
Venous blood lactate obtained by standard venipuncture together with other essential blood works before giving antibiotics or intravenous fluid, if required. Lactate level is measured by Epoc® point-of-care blood analyzer (Epocal Inc., Ottawa, ON, Canada) within 5 minutes after obtaining the venous sample without any preservative.
| Enrollment: | 392 |
| Study Start Date: | March 2013 |
| Study Completion Date: | January 2015 |
| Primary Completion Date: | November 2014 (Final data collection date for primary outcome measure) |
| Groups/Cohorts |
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High lactate
Initial venous lactate level equal to or more than 2.0 mmol/L
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Low lactate
Initial venous lactate level less than 2.0 mmol/L
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Detailed Description:
Blood lactate is one of the markers that can predict the organ failures and mortality in emergency department (ED) patients with sepsis. Regarding its predictive role in the clinical deterioration in normotensive sepsis patients, a recent prospective observational study of the patients with moderately-high serum lactate (2.0-3.9 mmol/L) showed that one-forth of the patients eventually developed progressive organ dysfunctions or required vasopressor or mechanical ventilator. Unfortunately, low serum lactate (< 2.5 mmol/L) was still found up to 50% of overt septic shock patients, even in vasopressor-dependent cases. For the prognostic role on mortality, numbers of articles showed that blood lactate can also predict death in sepsis patients, especially in those who are elderly and critically-ill. However, no previous study was done in younger patients since lactate kinetics in the body may differ among the age groups. The primary aim of our study is to investigate the role of initial venous lactate levels in predicting the chance of severity progression to overt septic shock especially in non-elderly patients who suspected to have acute infections and without hemodynamic shock in ED. The secondary outcomes are to evaluate its prognostic role on hospital length of stay and 30-day mortality of this target population.
Eligibility| Ages Eligible for Study: | 18 Years to 65 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
Emergency department patients of King Chulalongkorn Memorial Hospital (a 1500-bed, tertiary-care, university-affiliated urban hospital)
Inclusion Criteria:
- Age 18 to 65 years
- Confirmed or suspected diagnoses of acute infections (within 7 days)
- Major infections (e.g. Acute pyelonephritis, Acute bronchitis/pneumonia, Acute hepatobiliary tract infections, intraabdominal abscesses, meningitis and other central nervous system infections, soft tissue infections involving more than 10 square centimeters of the skin surface or deeper down beyond the dermis, significant tropical infections; dengue fever, leptospirosis, typhus fevers, or high fever from any infectious sources)
- Systolic blood pressure more than 90 mmHg at presentation
- Mean arterial pressure more than 70 mmHg at presentation
Exclusion Criteria:
- Duplicated cases that have participated in this study during the study period
- Overt organ hypoperfusion (e.g. cold, clammy or mottling skin, altered mental status; Glasgow Coma Scale equal to or less than 12 or decrease > 1 compared with the baseline)
- Pulse oximetry equal to or less than 90% at ambient air
- received intravenous fluid more than 10 ml/kg prior to the venous blood sampling
- received intravenous antibiotics for more than 1 hours prior to the venous blood sampling
- Minor infections (e.g. uncomplicated upper respiratory tract infections, gastroenteritis, minor skin infections)
- currently taking antiretroviral drugs
- having or suspicious of having seizures in the past 72 hours
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT01947127
| Thailand | |
| Emergency Medicine Unit, King Chulalongkorn Memorial Hospital | |
| Patumwan, Bangkok, Thailand, 11130 | |
| Principal Investigator: | Khrongwong Musikatavorn, MD | Department of Medicine, Facalty of medicine, Chulalongkorn University |
More Information
No publications provided
| Responsible Party: | Khrongwong Musikatavorn, MD., Khrongwong Musikatavorn, MD, Chulalongkorn University |
| ClinicalTrials.gov Identifier: | NCT01947127 History of Changes |
| Other Study ID Numbers: | 793/2012 |
| Study First Received: | September 10, 2013 |
| Last Updated: | February 2, 2015 |
| Health Authority: | Thailand: Ethical Committee |
Keywords provided by Chulalongkorn University:
|
Lactate Sepsis Septic shock Disease progression Prognosis |
Additional relevant MeSH terms:
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Disease Progression Shock, Septic Disease Attributes Infection Inflammation |
Pathologic Processes Sepsis Shock Systemic Inflammatory Response Syndrome |
ClinicalTrials.gov processed this record on March 03, 2015