Predictive Value of Serum Lactate in Determining Mortality in Patients with Septic Shock Undergoing Surgery
DOI:
https://doi.org/10.53350/pjmhs02026203.4Keywords:
Septic shock, Serum lactate, Mortality, Surgery, Lactate clearance, Critical care.Abstract
Background: Septic shock is a leading cause of death in the perioperative period and a significant problem in emergency surgery. Timely recognition of those at risk of death is crucial. Serum lactate is a valuable marker of tissue hypoperfusion and metabolic derangement, but its role in predicting mortality in surgical patients with septic shock needs to be explored.
Objective: To evaluate the usefulness of serum lactate in predicting mortality in patients with septic shock who require surgery.
Methods: This prospective observational study was carried out in the Department of General Surgery, Sughra Shafi Medical Complex Narowal between 1st January 2024 and 31st March 2025. Consecutively, 80 adult patients with septic shock who required surgery were included in the study. Lactate was measured at the time of admission and at 6 hours following resuscitation. Lactate clearance was determined, and outcomes were monitored until discharge or death. Statistical analysis was performed using SPSS-26.
Results: The average age of the patients was 54.1±15.2 years, and 61.3% were men. In-hospital mortality was 35.0%. Admission serum lactate levels were significantly higher in non-survivors 5.9±1.5 mmol/L than in survivors 3.4±1.0 mmol/L. Lactate levels at 6 hours were also higher in non-survivors 5.0±1.3 mmol/L than survivors 2.5±0.8 mmol/). Lactate clearance was also significantly lower in non-survivors 10.8±6.3% than in survivors 26.7±9.4%. Lactate levels at admission of 4.0 mmol/L or greater were significantly associated with mortality (p < 0.001).
Conclusion: Lactate is an important predictor of death in surgical patients with septic shock. High admission lactate, persistent hyperlactatemia and low lactate clearance are all predictors of poor outcome.
References
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47(11):1181-1247.
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet 2020;395(10219):200-11.
Vincent JL, Jones G, David S, Olariu E, Cadwell KK. Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis. Crit Care 2019;23(1):196.
Lat I, Coopersmith CM, De Backer D, Jaber S, Marik PE, Ospina-Tascón GA, et al. The surviving sepsis campaign: fluid resuscitation and vasopressor therapy research priorities in adult patients. Intensive Care Med Exp 2021; 9(1):10.
Nunnally ME, Ferrer R, Martin GS, Martin-Loeches I, Machado FR, De Backer D, et al. The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis. Intensive Care Med Exp 2021;9(1):34.
Jouffroy R, Léguillier T, Gilbert B, Tourtier JP, Bloch-Laine E, Ecollan P, et al. Prehospital lactate clearance is associated with reduced mortality in patients with septic shock. Am J Emerg Med 2021;46:367-73.
Espinosa-Almanza CJ, Sanabria-Rodríguez O, Riaño-Forero I, Toro-Trujillo E. Fluid overload in patients with septic shock and lactate clearance as a therapeutic goal: a retrospective cohort study. Rev Bras Ter Intensiva 2020;32(1):99-107.
Jobin SP, Maitra S, Baidya DK, Subramaniam R, Prasad G, Bhattacharjee S, et al. Role of serial lactate measurement to predict 28-day mortality in patients undergoing emergency laparotomy for perforation peritonitis: prospective observational study. J Intensive Care 2019;7:58.
Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit Care 2020;24(1):407.
Ryoo SM, Lee J, Lee YS, Lee JH, Lim KS, Huh JW, et al. Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by Sepsis-3. Crit Care Med 2018; 46(6):e489-95.
El-Soda SSE, Mohamed KAE, Ali ASA, et al. The association of dynamic lactate indices and lactate clearance with mortality in septic patients with acute kidney injury requiring continuous renal replacement therapy. Egypt J Crit Care Med 2025;12:9.
Chang WH, Hu TY, Kuo LK. Peak lactate within 24 h and mortality in septic shock patients receiving continuous renal replacement therapy: a real-world cohort from an Asian ICU. Life (Basel) 2025;16(1):62.
Demirel B, Yılmaz F, Korkut S, et al. The role of the serum lactate level at the first admission to the emergency department in predicting mortality. Am J Emerg Med 2021;45:495-500.
Casserly B, Phillips GS, Schorr C, Dellinger RP, Townsend SR, Osborn TM, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med 2020; 48(12): e1223-31.
Ospina-Tascón GA, Hernández G, Alvarez I, Calderón-Tapia LE, Manzano-Núñez R, Sánchez-Ortiz AI, et al. Effects of very early start of norepinephrine in patients with septic shock: a propensity score-based analysis. Crit Care 2020; 24(1):52.
Hernández G, Ospina-Tascón GA, Damiani LP, Estenssoro E, Dubin A, Hurtado J, et al. Effect of a resuscitation strategy targeting peripheral perfusion status versus serum lactate levels on 28-day mortality among patients with septic shock. JAMA 2019;321(7):654-64.
Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care 2020;10(1):111.
Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2023;389(18):1726–1736.
Yatabe T, Inoue S, Sakaguchi M, Egi M. The optimal timing of lactate measurement in septic shock and its prognostic value in critically ill surgical patients. BMC Anesthesiol 2021; 21(1): 238.
Martin-Loeches I, Levy MM, Artigas A. Management of severe sepsis: advances, challenges, and current status. Lancet Respir Med 2022;10(11):1063-74.
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2026 SHAFQATULLAH, INAYAT HUSAIN ANJUM, MUHAMMAD TARIQ BASHIR, FARHAT ULLAH, LUTFULLAH, KAMRAN CHEEMA
This work is licensed under a Creative Commons Attribution 4.0 International License.
