Comparison of lactate values obtained from different sites and their clinical significance in patients with severe sepsis

Comparison of lactate values obtained from different sites and their clinical significance in patients with severe sepsis

Alternative title Comparação de valores de lactato obtidos em diferentes sítios e sua importância clínica em pacientes com sepse grave
Author Nascente, Ana Paula Metran Autor UNIFESP Google Scholar
Assunção, Murillo Autor UNIFESP Google Scholar
Guedes, Carla Janaina Autor UNIFESP Google Scholar
Freitas, Flavio Geraldo Rezende Autor UNIFESP Google Scholar
Mazza, Bruno Franco Autor UNIFESP Google Scholar
Jackiu, Miriam Autor UNIFESP Google Scholar
Machado, Flavia Ribeiro Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract CONTEXT AND OBJECTIVE: The ideal site for lactate collection has not been clearly established. This study aimed to evaluate associations between lactate levels in arterial blood (Lart), peripheral venous blood (Lper) and central venous blood (Lean) in patients with severe sepsis or septic shock.DESIGN AND SETTING: Cross-sectional analytical study in an tertiary university hospital.METHOD: Samples from patients with a central venous catheter and from healthy volunteers (control group) were collected. Blood was drawn simultaneously for measurements of Lart, Lper and Lcen, and the first sample was collected less than 24 hours after the onset of organ dysfunction. The results were analyzed using Pearson correlation, Bland-Altman and McNemar tests.RESULTS: A total of 238 samples were collected from 32 patients. The correlation results were r = 0.79 (P < 0.0001) for Lart/Lper and r = 0.84 (P < 0.0001) for Lart/Lcen. Bland-Altman showed large limits of agreement: -3.2 +/- 4.9 (-12.8 to 6.4) and -0.8 +/- 5.9 (-12.5 to 10.8), for Lper and Lcen respectively. lathe control group, there was greater correlation (r = 0.9009, P = 0.0004) and agreement: -0.7 +/- 1.2 (-3.1 to 1.7). Regarding clinical intervention, there was good agreement between Lart/Lcen (96.3%; three disagreements), with worst results for Lart/Lper (87.0%) with 10 cases of disagreement (P = 0.04). In eight patients (80.0%) Lper was higher than Lart.CONCLUSION: Lcen, and not Lper, can replace Lart with good correlation and clinical agreement. Lper tends to overestimate Lart, thus leading to unnecessary therapeutic interventions.
Keywords Lactic acid
Perfusion
Sepsis
Shock, septic
Hemodynamics
Language English
Date 2011-01-06
Published in Sao Paulo Medical Journal. Sao Paulo: Associacao Paulista Medicina, v. 129, n. 1, p. 11-16, 2011.
ISSN 1516-3180 (Sherpa/Romeo, impact factor)
Publisher Associacao Paulista Medicina
Extent 11-16
Origin http://dx.doi.org/10.1590/S1516-31802011000100003
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000288620300003
SciELO ID S1516-31802011000100003 (statistics in SciELO)
URI http://repositorio.unifesp.br/11600/45550

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