Author(s): Siddaraj Wali1, Veerabhadra Swamy
Sepsis is a lethal disease that has a complex pathophysiology including a dysregulated inflammatory response, endothelial injury, microvascular thrombosis, vasoplegia and myocardial depression leading to multiorgan failure. Prompt recognition of sepsis, early initiation of antibiotics, source control, optimal fluid and vasopressor therapy are of utmost importance. Early diagnosis of sepsis is very critical for the timely and efficient use of treatment modalities, however, there are no reliable, specific biomarkers that can guide the diagnosis of sepsis. Cardiopulmonary failure, sepsis, trauma, oncologic pathology and so can lead to lactic acidosis. The aim of the study is to evaluate the serum lactic acid levels as a prognostic marker in various type of shock.
MATERIALS AND METHODS
It is a prospective clinical study with 50 patients studied for 1 year. To study the values of serum lactate levels in shock patients. Statistical analysis- Chi-square test 2. Student’s t-test (two tailed, independent).
Out of the 50 patients included in the study, the incidence of shock was found to be high in the 21-30 years age group, 13 (26%). This study of ours revealed the most common focus of sepsis as respiratory tract (60%), followed by urinary tract (25%), skin and soft tissue (15%). Out of the 18 patients who died, it was noted that mortality rates were highest 10 (55.5%) in patients with initial (0 hours) high positive serum lactate levels (>4 mmol/L). Out of the 32 patients who recovered, majority 21 (65.6%) had low positive serum lactate levels (0-2.5 mmol/L) on admission (0 hours). Serum lactate level is significantly reduced in recovered patients.
Approximately, 30% to 45% of patients with septic shock and 60% to 90% of patients with cardiogenic shock die within 1 month of presentation. Lactate was chosen because it is used as a prognostic marker of global hypoxia. Serial lactate values followed over a period of time can be used to predict impending complications or grave outcome in patients of shock. Interventions that decrease lactate values to normal may improve chances of survival and can be considered effective therapy.