Co-Evaluation of Lactate, Base Excess and Albumin as Predictor of Mortality in Sepsis by Excluding the Factors Which Affect Their Levels
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Purpose
Our aim in this study is to determine the benefits of serum lactate, albumin and base excess values in predicting prognosis and mortality in patients with sepsis or septic shock when evaluated together.
Methods
We performed a retrospective observational study. Included 217 patients admitted to Hacettepe University Hospital Adult Emergency Department, that were 18-year-old and more, and had 2 or more SOFA scores. We evaluated admission hour, 24. hour and 48. Hour lactate, albumin and base excess. We searched changes of the lactate, albumin and base excess values and calculate the hospital mortality and 90-days-mortality.
Results
Decrease in 0-24-48th hour albumin values increases the mortality of sepsis patients in our study. While 0-48th hour lactate values do not affect the hospital mortality, the increase in the 24th hour lactate value increases the hospital mortality. The increase in 0-48th hour lactate values increases the 90-day mortality. Changes of base excess values had no effect on hospital mortality and 90-day mortality. There was no effect of lactate, albümin and base excess values on mortality in patients with septic shock. When the mortality rates are analyzed according to the lactate clearance of patients with sepsis, hospital mortality increases only as 24-hours lactate clearance decreases. Alactic base excess has no effect on the mortality. While no significant AUC value was found for base excess in ROC analyzes; the AUC values of lactate and albumin are significant, but their sensivity is low since the AUC values found for lactate and albumin are below 0.70. In ROC analyzes for lactate clearance, the AUC value for 24-hour lactate clearance is significant, but the sensivity of the AUC value is low. The areas under the curve (AUC) were not statistically significant in the ROC analyzes for the alactic base excess.
Conclusions
Contrary to the literature, lactate, albumin and base excess were found to have low sensitivity in determining prognosis and mortality in our study. When factors that may affect serum lactate, albumin and base excesss (such as chronic liver diseases, chronic kidney diseases, metformin use) are excluded, the values of these biomarkers in determining mortality in sepsis and septic shock decrease.
