Serum lactate levels and lactate clearance are commonly used to identify occult hypoperfusion and to characterize severity of illness in septic patients. While elevated lactate levels have been repeatedly shown to correlate with reduced survival, the independent predictive power of lactate in combination with other markers of illness severity (e.g. abnormal vital signs) has been questioned (doi: dx.doi.org/10.1136/bmj.i4030).
The Sepsis III task force included lactate as a candidate variable in the development of qSOFA but it did not meet the threshold for inclusion (perhaps due to a high level of missingness in the derivation dataset). In a post-hoc analysis using a dataset where lactate was common, adding lactate to cases where qSOFA=1 improved predictive validity and identified a higher risk patient cohort. Lactate was also included in the clinical criteria for septic shock (sepsis + vasopressors + lactate >2).
What do you see as the role of lactate measurement in patients with suspected infection in a post-Sepsis III world? Should the inability of many hospital world-wide to rapidly and reliably measure lactate play a role in how we consider this question?
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