Prognostic significance of early (first 6 hours) versus delayed changes in serum lactate and procalcitonin in septic shock: A prospective observational cohort study.

Mohammad Shoaib; Sourabh Kumar; Ritwik Chakraborty; Shalendra Goel

doi:10.51168/4gs67w38

Authors

Mohammad Shoaib Consultant, Department of Critical care medicine, Livasa hospital khanna Punjab, India
Sourabh Kumar Assistant Professor, Department of Critical Care Medicine, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University, Jollygrant, Dehradun, India
Ritwik Chakraborty Consultant, Department of Critical Care medicine, Max Superspeciality Hospital Vaishali Ghaziabad, U.P. India
Shalendra Goel Director, Department of Critical Care Medicine, Max Hospital, Noida UP, India

DOI:

https://doi.org/10.51168/4gs67w38

Keywords:

Glasgow Coma Scale, Sequential Organ Failure Assessment, National Early Warning Score, Sepsis, Septic shock, Procalcitonin

Abstract

Background:

Sepsis and septic shock are major causes of mortality among critically ill patients. Serum lactate and procalcitonin are important biomarkers for prognostic evaluation and monitoring treatment response.

Objective:

To assess the prognostic significance of serial changes in serum lactate and procalcitonin and their clearance in predicting outcomes in patients with sepsis and septic shock.

Methods:

This prospective observational cohort study included 100 adult intensive care unit patients with suspected or confirmed sepsis. Serum lactate was measured at admission, 6, 12, and 24 hours, while procalcitonin was measured at admission and on day 3. Lactate and procalcitonin clearance rates were calculated. Clinical severity was assessed using the Glasgow Coma Scale, Sequential Organ Failure Assessment score, and National Early Warning Score.

Results:

The mean age was 57.8 ± 13.6 years, 56% were male, and overall mortality was 21%. Non-survivors had significantly higher baseline lactate and procalcitonin levels and markedly lower clearance rates than survivors (p<0.0001). Lactate levels progressively declined over 24 hours in survivors, indicating improved tissue perfusion. Procalcitonin clearance demonstrated excellent diagnostic accuracy for predicting mortality, while higher Sequential Organ Failure Assessment and National Early Warning Score values were associated with poorer outcomes.

Conclusion:

Elevated serum lactate and procalcitonin levels with reduced clearance are associated with increased mortality in sepsis and septic shock. Serial biomarker monitoring combined with clinical severity scores may improve early risk stratification and prognostic assessment.

Recommendation:

Routine serial monitoring of lactate and procalcitonin clearance should be incorporated into sepsis management to facilitate early identification of high-risk patients.

Author Biographies

Mohammad Shoaib, Consultant, Department of Critical care medicine, Livasa hospital khanna Punjab, India

is a Consultant in the Department of Critical Care Medicine at Livasa Hospital, Khanna, Punjab, India. His clinical and research interests include sepsis, septic shock, critical care medicine, and biomarker-based prognostic assessment.
Sourabh Kumar, Assistant Professor, Department of Critical Care Medicine, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University, Jollygrant, Dehradun, India

is an Assistant Professor in the Department of Critical Care Medicine at the Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India. His research interests include intensive care medicine, sepsis management, and clinical outcomes research.
Ritwik Chakraborty, Consultant, Department of Critical Care medicine, Max Superspeciality Hospital Vaishali Ghaziabad, U.P. India

is a Consultant in the Department of Critical Care Medicine at Max Super Speciality Hospital, Vaishali, Ghaziabad, India. His areas of interest include critical care, emergency medicine, and biomarker-guided management of critically ill patients.
Shalendra Goel, Director, Department of Critical Care Medicine, Max Hospital, Noida UP, India

is the Director of the Department of Critical Care Medicine at Max Hospital, Noida, India. His research interests include critical care medicine, sepsis, organ dysfunction, and evidence-based intensive care practice.

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