UMEM Educational Pearls

-Initial lactate clearance over 2 hours has been used to measure pt response to resuscitation in sepsis. However, data supporting its prognostic use is lacking.
-Single center, retrospective cohort study in large academic center
-Adult patients (4,775) admitted through ED with suspected infection
-Lactate clearance defined as 10% decrease in 2 to 12 hrs
-Multivariable logistic regression adjusting for age, sex, cirrhosis, ESRD
-Lactate trajectories highly variable
-Lactate clearance was highly confounded by patient comorbidities (particularly cirrhosis)
-24-h change in peak lactate was a better prognostic indicator (but still poor)
-In the ED, caution should be used when using lactate clearance as a single marker for assessment/prognosis, particularly if the pt has other comorbidities such as cirrhosis


McCallister R, Nuppnau M, Sjoding MW, Dickson RP, Chanderraj R. In patients with sepsis, initial lactate clearance is confounded highly by comorbidities and poorly predicts subsequent lactate trajectory. CHEST. 2023;164(3):667-669.