LACSI Study: Lactate and Shock Index, to Verify Hemodynamic Co-herence in Patients with Sepsis in the Emergency Department

We aimed to evaluate whether, in the early phase of sepsis, the coherence between ab-normalities in parameters of macrocirculation — using the shock index (SI, HR/SBP) — and microcirculation (lactate levels, LAC) is maintained and yields prognostic value. We performed a retrospective analysis, including all patients with sepsis admitted to the Emergency Department High-Dependency Unit, between 2008 and 2024, June. The endpoints were day-7 and day-28 mortality. Upon admission to the Emergency De-partment (T0), the population was divided into 3 subgroups, based on the following criteria: G1, (235 patients, 17%) with SI < 0.7 and LAC < 2 mmol/L; G2 with SI > 0.7 or Lac > 2 mmol/L; G3 SI > 0.7 and Lac > 2 mmol/L. We included 1392 patients, mean age 75±14 years, 56% male. At the univariate analysis, we confirmed that G3 patients had a significantly higher day-7 mortality risk (OR 2,1, 95% CI 1.40-3.22) and day-28 mor-tality risk (OR 1,56, 95% CI 1.1 -2.1) than other subgroups. After adjustment for age and SOFA score, the higher day-7 mortality rate was confirmed (OR 1.63, 95%CI 1.05-2.55, p=0.032) for G3 patients. We concluded that only an associated abnormality of macro- or microhemodynamics was independently associated with an increased mortality.