The association of dynamic lactate indices and lactate clearance with mortality in septic patients with acute kidney injury requiring continuous renal replacement therapy

Abstract

Abstract Background Sepsis is a frequently encountered severe medical condition that impairs multiple bodily systems and results in inadequate tissue perfusion. Aim To evaluate the clinical effectiveness of measuring lactate at various time intervals to predict mortality at 48 h and 28 days in septic cases who suffer from acute kidney injury (AKI) and who need continuous renal replacement therapy (CRRT). Patients and methods This observational prospective clinical trial was performed on 100 cases who were admitted to the ICU Department diagnosed as having severe sepsis and/or septic shock complicated with S-AKI and required RRT at the Critical Care Department (ICU), Kasr-Alainy Hospitals, Cairo University, from March 2022 to November 2023. Results Comparison between all lactate indices post CVVHDF and mortality at 48 h and 28 days showed a statistically significant difference with a significant P value below 0.001. First lactate clearance cut-off value below −1.5 with sensitivity and specificity of 100%. The second lactate clearance cut-off value is below −4.9 with a sensitivity and specificity of 100%. Third lactate clearance cut-off value below −4.5 with a sensitivity of 98.3% and specificity of 100%. Fourth lactate clearance cut-off value below −0.6 with a sensitivity of 91.7% and specificity of 70%. Conclusion The mortality incidence in septic AKI cases undergoing CVVHDF was correlated with lactate clearance and lactate indices following the initiation of CRRT during the 48-h and 28-day periods. These outcomes recommend that continuous lactate measurements may offer more accurate prognostic information compared to initial lactate levels in these patients.