Serial measurement of arterial lactate concentrations as a prognostic indicator in relation to the incidence of disseminated intravascular coagulation in patients with systemic inflammatory response syndrome

To demonstrate the prognostic value of measuring blood lactate concentratio ns and to investigate the mechanisms of lactate production in patients with systemic inflammatory response syndrome (SIRS), we conducted a prospective cohort study. Among 22 patients with SIRS, there were 9 survivors and 13 n onsurvivors. Serial arterial lactate concentrations were measured on the da y of admission to the intensive care unit (day 0), then on days 1-4. The su bjects of this study consisted of 14 patients with SIRS, 6 with severe seps is, and 2 with septic shock. On admission, the lactate concentrations did n ot differ between the two groups, but remained high in the nonsurvivors thr oughout the study period, while they progressively decreased in the survivo rs. The incidence of disseminated intravascular coagulation (DIC) was signi ficantly higher in the nonsurvivors than in the survivors. The nonsurvivors had persistently higher DIC scores and lower platelet counts than the surv ivors. The changes in lactate concentration over time were statistically di fferent between the patients with DIC and those without DIC. The findings o f this study clearly demonstrated that serial arterial lactate measurements can predict a poor outcome in patients with SIRS, severe sepsis, or septic shock. DIC might play an important role in the pathogenesis of lactate pro duction in these newly defined critically ill patients.