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Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country

Fazal Rehman
Fazal Rehman
, 
Saad Bin Zafar
Saad Bin Zafar
, 
Adil Aziz
Adil Aziz
, 
Abdul Aziz
Abdul Aziz
, 
Pirbhat Shams Memon
Pirbhat Shams Memon
, 
Taymmia Ejaz
Taymmia Ejaz
 und 
Summaira Aziz
Summaira Aziz
   | 08. Feb. 2023
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Article Category: Research Article
Online veröffentlicht: 08. Feb. 2023
Seitenbereich: 30 - 38
Eingereicht: 19. Apr. 2022
Akzeptiert: 14. Jan. 2023
DOI: https://doi.org/10.2478/jccm-2023-0005
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© 2023 Fazal Rehman, Saad Bin Zafar, Adil Aziz, Abdul Aziz, Pirbhat Shams Memon, Taymmia Ejaz, Summaira Aziz, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Sociodemographic and clinical characteristics of the patients by mortality and organ dysfunction

Mortality
 Organ Dysfunction
Variables No
 Yes
 P-Value No organ dysfunction
 Single organ dysfunction
 Multi organ dysfunction
 P-Value
n % n % n % n % n %
Age (Years)
20 to 40 Years 54 29.1 3 9.1 21 31.3 23 24.5 7 18.9
41 to 60 years 46 27.9 11 33.3 0.054 18 26.9 27 28.7 12 32.4 0.71
≥ 60 years 71 43 19 57.6 28 41.8 44 46.8 18 48.6
Gender
Male 85 51.5 16 48.5 0.75 35 52.2 49 52.1 17 45.9 0.79
Female 80 48.5 17 51.5 32 47.8 45 47.9 20 54.1
Lactate Clearance
Early 90 78.9 18 54.5 0.005 43 84.3 47 68.1 18 66.7 0.09
Delayed 24 21.1 15 45.5 8 15.7 22 31.9 9 33.3
Diabetes Mellitus
No 128 77.6 15 45.5 <0.001 48 71.6 67 71.3 28 75.7 0.41
Yes 37 22.4 18 54.5 19 28.4 27 28.7 9 24.3
Hypertension
No 115 69.7 13 39.4 41 61.2 66 70.2 21 56.8
Yes 50 30.3 20 60.6 0.001 26 38.8 28 29.8 16 43.2 0.26
Ischemic Heart Disease
No 140 84.8 22 66.7 0.013 58 86.6 73 77.7 31 83.8 0.33
Yes 25 15.2 11 33.3 9 13.4 21 22.3 6 16.2
Chronic kidney disease
No 148 89.7 21 36.4 <0.001 62 92.5 79 84 28 75.7 0.059
Yes 17 10.3 12 63.6 5 7.5 15 16 9 24.3
Chronic Liver Disease
No 159 96.4 29 87.9 67 100 87 92.6 34 91.9
Yes 6 3.6 4 12.1 0.04 0 0 7 7.4 3 8.1 0.06
Lung Disease
No 137 83 22 66.7 0.031 60 89.6 72 76.6 27 73 0.05
Yes 28 17 11 33.3 7 10.4 22 23.4 10 27
Any procedure done
No 147 89.1 20 60.6 <0.001 58 86.6 83 88.3 26 70.3 0.03
Yes 18 10.9 13 39.4 9 13.4 11 11.7 11 29.7
Length of Stay
≤ 7 days 134 81.2 13 39.4 49 73.1 73 77.7 25 67.6
> 7 days 31 18.8 20 60.6 <0.001 18 26.9 21 22.3 12 32.4 0.47
Platelets
>100000 143 86.7 22 66.7 0.005 56 83.6 74 78.7 35 94.6 0.09
Less than 100000 22 13.3 11 33.3 11 16.4 20 21.3 2 5.4
Blood Transfusion
Yes 18 10.9 4 12.1 0.84 9 13.4 9 9.6 4 10.8
No 147 89.1 29 87.9 58 86.6 85 90.4 33 89.2 0.74
Glasgow Coma Scale
Mild (14-15) 144 87.3 7 21.2 54 80.6 73 77.7 24 64.9
Moderate (9-13) 20 12.1 18 54.5 <0.001 11 16.4 19 20.2 8 21.6 0.05
Severe (3-8) 1 0.6 8 24.2 2 3 2 2.1 5 13.5

Association between delayed lactate clearance and mortality and organ dysfunction in patients admitted in a tertiary care hospital (n=198)

Risk factors for Mortality
 Risk factors for Organ Dysfunction
Variables Crude
 Adjusted Estimates
 Crude
 Adjusted Estimates
OR 95%CI AOR 95%CI OR 95%CI AOR 95%CI
Age (Years)
20 to 40 Years 1 1 1
41 to 60 years 3.83 1.01 14.59 29.19 0.21 41.5 1.52 0.68 3.34 NA
≥ 60 years 4.28 1.2 15.27 2.77 0.02 33.7 1.55 0.76 3.16
Lactate Clearance
Early 1 1 1 1
Delayed 3.12 1.37 7.09 7.67 1.11 53.26 2.56 1.07 6.13 2.18 0.87 5.49
Diabetes Mellitus
No 1 1 1 1
Yes 4.15 1.91 9.03 8.56 1.18 62.01 0.95 0.49 1.84 0.53 0.22 1.31
Hypertension
No 1 1 1 1
Yes 3.54 1.63 7.67 56.36 3.57 889.83 0.79 0.43 1.47 0.6 0.27 1.33
Chronic kidney disease
No 1 1 1
Yes 4.97 2.08 11.86 NA 1.01 2.78 7.66 6.13 1.72 21.86
Lung Disease
No 1 NA 1 1
Yes 2.46 1.07 5.61 1.15 2.77 6.67 2.61 0.97 6.99
Ischemic Heart Disease
No 1 1 1 NA
Yes 2.8 1.21 6.48 0.15 0.01 1.77 1.67 0.73 3.79
Any procedure done
No 1 1 1
Yes 5.31 2.26 12.45 NA 1.3 0.56 3.01 1.41 0.55 3.63
Length of Stay
≤ 7 days 1 1 1 NA
> 7 days 6.65 2.98 14.8 2.59 0.53 12.7 0.91 0.47 1.79
Platelets
>100000 1 1 1 NA
Less than 100000 3.25 1.38 7.61 305.74 17.9 5195.87 1.03 0.46 2.27
Glasgow Coma Scale
Mild (14-15) 1 1 NA
Moderate (9-13) 18.51 6.87 49.84 134.86 11.17 1627.16 1
Severe (3-8) 164.57 18.01 1504.6 1251.02 28.84 54260.43 1.36 0.63 2.97 NA
CRP 0.98 0.97 0.99 0.97 0.94 1 1.95 0.39 9.71

Sociodemographic and clinical characteristics of the patients admitted in a tertiary care hospital (n=198)

Variables Frequency (n) Percentage (%)
Age (Years)
20 to 40 Years 51 25.7
41 to 60 years 57 28.7
≥ 60 years 90 45.45
Gender
Male 101 51
Female 97 49
Hypertension
Yes 70 35.4
No 128 64.6
Diabetes Mellitus
Yes 55 27.8
No 143 72.2
Chronic Kidney Disease
Yes 29 14.6
No 169 85.4
Ischemic Heart Disease
Yes 36 18.2
No 162 81.8
Lung Disease
Yes 39 19.7
No 159 80.3
Chronic Liver Disease
Yes 10 5.1
No 188 94.9
Any Procedures done
Yes 167 84.3
No 31 15.7
Length of stay
≤ 7 days 147 74.2
> 7 days 51 25.8
Platelets
>100000 165 83.3
Less than 100000 33 16.7
Blood Transfusion
Yes 22 11.1
No 176 88.9
Glasgow Coma Scale
Mild (14-15) 151 76.3
Moderate (9-13) 38 19.2
Severe (3-8) 9 4.5

Source of sepsis and organisms grown in cultures

Variables Frequency (n) Percentage (%)
Sepsis source
Pneumonia 97 48.9
Viral fever/Dengue Fever 33 16.7
UTI/Pyelonephritis 32 16.2
Enteric fever 9 4.5
Meningitis 8 4
Infected wound/Bedsore 8 4
Spontaneous bacterial 5 2.5
peritonitis
Malaria 3 1.5
Viral hepatitis 3 1.5
Blood cultures
E.coli 10 5.10
Salmonella typhi 9 4.5
Klebsiella 5 2.5
Candida auris 2 1.1
Proteus 1 0.5
Staph aureus 1 0.5
Urine cultures
E.coli 9 4.5
Klebsiella 4 2
Candida 3 1.5
Tracheal cultures
Klebsiella 8 4
Acinetobacter 6 3
Staph aureus 5 2.5
E.coli 2 1.1
Pseudomonas 2 1.1
Candida 1 0.5
Pus cultures
E.coli 5 2.5
Staph aureus 3 1.5
Streptococcus 1 0.5
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