Serial Serum Lactic Acid in Pregnancy-Associated Sepsis for Maternal Outcome

Abstract

Objective: To correlate serial monitoring of lactic acid in pregnancy-associated sepsis (PAS) subjects with maternal prognosis. Methods: All pregnant, post-abortal (2 weeks) and postpartum women with suspected sepsis fulfilling any 2 of the Quick Sequential Organ Failure Assessment criteria were considered as cases. Lactic acid was measured at 0, 24 and 48 h of admission, and lactate clearance was calculated. Results: The mean value of lactic acid was significantly higher in the Intensive Care Unit (ICU) group than the Non-ICU group at 0, 24, and 48 h with values being (6.00 ± 2.46 mmol/l vs 3.25 ± 1.92 mmol/l), (4.44 ± 2.24 mmol/l vs 2.91 ± 1.77 mmol/l) and (5.65 ± 2.91 mmol/l vs 2.99 ± 1.93 mmol/l), respectively. Lactic acid in the survivor group was significantly lower as compared to the mortality group (3.79 ± 0.32 mmol/l vs 7.3 ± 0.56 mmol/l). A cut-off of 3.8 mmol/l with area under the curve of 0.814 has a sensitivity of 84% and specificity of 68% for predicting ICU admission. The mean lactate clearance was 46% in cases who survived and 22.5% in cases who had mortality. When lactate clearance was 60%, no mortality was seen, whereas when there was 100% rise in lactic acid, they all had mortality. Conclusion: The mean lactic acid at 0, 24 and 48 hours was significantly higher in the ICU group as compared to the Non-ICU group. Serum lactic acid at zero hours of the presentation was significantly higher in ICU cases. Lactate clearance (fall) helps to prognosticate as fall of ≥ 60% lactic acid level is associated with 100% survival, whereas a rise of 100% in serum lactic acid is associated with 100% mortality.