B0501 - Serum Lactate Thresholds in the Diagnosis of Septic Shock in Patients With Cirrhosis: Validation of 2016 Surviving Sepsis Guidelines

Thomas N. Smith, MD, Chansong Choi, MD, MS, Puru Rattan, MD, Laura Piccolo Serafim, MD, Douglas A. Simonetto, MD, Alice Gallo De Moraes, MD
Mayo Clinic School of Graduate Medical Education, Rochester, MN

Introduction: The 2016 Surviving Sepsis guidelines adjusted the septic shock definition and criteria to better represent known pathophysiology and patient outcomes. One significant change was the lowering of serum lactate cutoff (2 mmol/L) to include patients with higher risk-adjusted hospital mortality. However, this increased hospital mortality has not been demonstrated in patients with known derangements in lactate metabolism and hemodynamics such as those with cirrhosis.

Methods: Retrospective cohort study of patients admitted to a Mayo Health System ICU for treatment of septic shock between 2006 and 2021 using a validated ICU Datamart. Patients with identified infection source and who received vasopressors to maintain mean arterial pressure (MAP) greater than 65 mmHg were included (N=1,609). Patients with cirrhosis documented on imaging and ICD codes (N=856) were compared to patients without cirrhosis (N=753). Subgroups were created based on ICU-admission lactate levels, and in-hospital mortality was compared in both cirrhosis and control groups.

Results: For cirrhosis and non-cirrhosis groups, ICU admission lactates between 2-4 and >4 mmol/L were associated with significantly increased in-hospital mortality. The cirrhosis subgroups of lactate < 2, 2-4, and >4 were found to have in-hospital mortalities of 22.0%, 29.5%, and 47.6%, respectively (P < 0.001). Non-cirrhosis subgroups of lactate < 2, 2-4, and >4 were found to have in-hospital mortalities of 17.1%, 23.9%, and 30.0% (P < 0.001). In a logistic regression model adjusting for age and gender, the interaction between presence of cirrhosis and lactate >4 mmol/L on in-hospital mortality was not statistically significant (OR 1.56, 95% CI .090, 2.72; p=0.12).

Discussion: Serum lactate levels at time of septic shock diagnosis between 2-4 mmol/L were associated with similarly increased in-hospital mortality in both cirrhosis and control groups. This supports the continued use of the 2.0 mmol/L lactate cutoff for septic shock definition in this population. Lactates >4 mmol/L were also associated with increased in-hospital mortality, demonstrating its importance in risk stratification for patients regardless of liver dysfunction.






Disclosures:


Thomas N. Smith, MD, Chansong Choi, MD, MS, Puru Rattan, MD, Laura Piccolo Serafim, MD, Douglas A. Simonetto, MD, Alice Gallo De Moraes, MD. B0501 - Serum Lactate Thresholds in the Diagnosis of Septic Shock in Patients With Cirrhosis: Validation of 2016 Surviving Sepsis Guidelines, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.