Prognostic Value of Lactate, Lactate Clearance, CRP, Procalcitonin, and Clinical Scoring Systems in Sepsis Patients: A Retrospective Observational Study

Authors : Mehmet Ali Cosar, Elif Neziroğlu Gür

Pages : 32-41

View : 48 | Download : 74

Publication Date : 2025-07-15

Article Type : Research Paper

Abstract :Sepsis is a critical health issue worldwide, associated with high mortality rates and significant healthcare burdens. Early identification and prognosis assessment of sepsis patients are essential for optimal management. Various biomarkers, including lactate, procalcitonin (PCT), and C-reactive protein (CRP), as well as clinical scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA), have been used to predict outcomes in sepsis patients. This study aimed to evaluate the prognostic effectiveness of lactate, lactate clearance, CRP, PCT, APACHE II, and SOFA scores in predicting mortality in sepsis patients. A retrospective observational study was conducted on 118 adult patients diagnosed with sepsis and admitted to the intensive care unit (ICU) between January 2016 and January 2019. Patient demographics, comorbidities, admission lactate, CRP, and PCT levels, serial lactate measurements at 6, 12, and 24 hours, and corresponding lactate clearances were recorded. APACHE II and SOFA scores were calculated at admission. Statistical analyses, including ROC curve analysis and logistic regression, were performed to determine the prognostic significance of these variables in predicting 28-day mortality. The overall 28-day mortality rate was 48.3%. Higher initial lactate levels were significantly associated with mortality (p<0.001), with an optimal cut-off value of ≥2.2 mmol/L, yielding a sensitivity of 82.5% and specificity of 85.2%. The 6-hour lactate level was also a strong predictor of mortality (AUC 0.839, p<0.001). Lactate clearance at 6, 12, and 24 hours demonstrated weaker prognostic value compared to initial lactate. Higher APACHE II (≥22) and SOFA (≥8) scores were significantly correlated with mortality (p<0.001). Logistic regression analysis revealed that male gender (OR: 6.53, p=0.018), hypotension at admission (OR: 29.78, p=0.011), initial lactate (OR: 11.95, p=0.004), and vasopressor requirement (OR: 114.98, p=0.007) were independent predictors of mortality. In conclusion; lactate and its serial measurements were found to be the most reliable biomarkers for predicting mortality in sepsis patients, with superior sensitivity and specificity compared to lactate clearance, CRP, and PCT. APACHE II and SOFA scores were also significant prognostic indicators. A comprehensive approach integrating multiple biomarkers and clinical scoring systems is recommended for optimal risk stratification in sepsis management.
Keywords : Sepsis, Laktat, Biyobelirteçler, APACHE II, SOFA

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