CORRELATION OF PROCALCITONIN VS SERUM LACTATE AT ADMISSION AND LACTATE CLEARANCE AS A PROGNOSTIC MARKER IN SEPSIS

Dr. Ankit P. Bhojani* and Dr. Yogitha C.

ABSTRACT

Background: Severe sepsis and septic shock, are the major cause of emergency room admission and are associated with high morbidity and mortality worldwide. Similarly mortality rate of sepsis in asia found to be 40%, so sepsis is still the leading cause of death. Delayed identification and inadequate resuscitation in severe sepsis and septic shock leads to the high mortality. Lactate clearance is a marker of tissue hypoxia and can be used as an indicator of mortality in sepsis, hyperlactemia and lactic acidosis is a biomarker for disease severity. Methods: It is a retrospective study conducted on 100 subjects age more than 18 years who were admitted with sepsis and septic shock in KIMS hospital, Bengaluru. Serum Procalcitonin, serum lactate at admission, at 24 hours and at 48 hours was measured. Lactate clearance was calculated as (latctate at admission – delayed lactate)/lactate at admission *100. Lactate clearance was defined as lactate decline of >40% or lactate normalization. APACHE 2 score was calculated as a control. Results: Out of the 100 patients 65 survived and 35 died, The blood lactate acid and procalcitonin levels at different time points were significantly lower among the patients in the survival control group than those in the death group, a substantial reduction in the APACHE II score was noted among those in the survival control group. Patients with lactate >5 mmol/L at admission and poor lactate clearance at 24 hours (i.e lactate decline <40%) had poor outcome. APACHE II score was positively correlated with the blood lactate acid level and the procalcitonin level. Conclusion: In the very busy emergency room where calculating APACHE 2 score or other scoring systems for sepsis is time consuming and expensive, serum lactate levels at admission and lactate clearance can be used as alternative marker to predict mortality in severe sepsis and septic shock. High lactate at admission and poor lactate clearance is an indicator of poor prognosis and correlates well with serum procalcitonin levels and APACHE 2 score.

Keywords: Sepsis, Septic shock, Lactate, lactate clearance, procalcitonin.