China
Africa
Explore chapters and articles related to this topic
Clinical Workflows Supported by Patient Care Device Data
Published in John R. Zaleski, Clinical Surveillance, 2020
Yet, often vital signs that are within a normal range, when taken together, are representative of conditions that merit further review. For instance, heart rate may be within a normal range, albeit at the uppermost end of the normal range (e.g., 100 beats per minute sinus rhythm). Yet, when taken together with another normal range parameter value, it may indicate a problem or may herald the onset of a problem, such as the case when blood pressure is marginally low (e.g., systolic blood pressure equal to 100 mmHg). Simple measures of performance can oftentimes be the most useful. The Shock Index falls into this category because it is a single parameter and requires very little interpretation. In the aforementioned study by Berger et al., patients having “…an abnormal SI of 0.7 or greater (15.8%) were three times more likely to present with hyperlactatemia than those with a normal SI (4.9%). The negative predictive value (NPV) of a SI ≥ 0.7 was 95%, identical to the NPV of SIRS”. Furthermore, it was observed that “SI ≥ 0.7 performed as well as SIRS in NPV and was the most sensitive screening test for hyperlactatemia and 28-day mortality. SI ≥ 1.0 was the most specific predictor of both outcomes.”
Abacavir
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Paul U. Cameron, Jason A. Trubiano
The initial studies of abacavir therapy showed association with a number of adverse effects, as summarized in Table 230.6. Many of these long-term studies included some adverse events seen in common with other nucleoside analog reverse transcriptase inhibitors. The incremental effect of addition of abacavir to a regimen and comparison with zidovudine with a similar background suggests that abacavir is associated with few specific adverse events seen with the drug combinations. Postmarket surveillance has reported a limited number of serious adverse events. Two serious adverse events are listed as a black box warning for abacavir. The adverse event that is most frequently limiting for abacavir therapy has been development of delayed hypersensitivity (DHS) reactions, which may be associated with fatal outcomes, particularly where there has been rechallenge. The other warning is for the potentially fatal outcome of hyperlactatemia and lactic acidosis.
Human Immunodeficiency Virus Infection
Published in Thomas T. Yoshikawa, Shobita Rajagopalan, Antibiotic Therapy for Geriatric Patients, 2005
Chronic hyperlactatemia can occur with NRTIs. Cases of severe lactic acidosis with hepatomegaly and steatosis are rare but associated with a high mortality rate. This may be related to mitochondrial toxicity. Nevirapine, an NNRTI, has the greatest potential for causing clinical hepatitis.
Hyperlactatemia is associated with increased risks of long-term mortality and major adverse cardiovascular events in sepsis survivors
Published in Infectious Diseases, 2023
Shu-Yu Ou, Yi-Jung Lee, Yu-Mei Chou, Gwo-Ching Sun, Yuan-Yi Chia
This study was performed at Kaohsiung Veterans General Hospital, a tertiary medical centre. From January 2012 to December 2018, we enrolled adult patients (age ≥ 20 years) who were discharged from hospitalisation for sepsis and severe sepsis (International Classification of Diseases [ICD] codes 038, 995.91, 995.92, A40, A41 and R65.20). For septic shock, we utilised the following criteria: ICD codes 785.52, R65.21, or sepsis with vasopressor use and lactate 18 mg/dL (>2 mmol/L) despite adequate fluid resuscitation [22–24]. Patients aged < 20 years, those who died during hospitalisation for sepsis, and for whom lactate measurements were not available were excluded from this study. A maximal lactate level in the first 24 h of sepsis recognition was used to identify tissue hypoperfusion in this study. According to the literature, hyperlactatemia is defined as a serum lactate level of >18 mg/dL (>2 mmol/L) [24,25]. The sepsis survivors were then divided into low (≤18 mg/dL) and high (>18 mg/dL) lactate groups. The index date was defined as the first date of discharge from hospitalisation for sepsis. The sepsis survivors were followed until death or the end of the study period. This study was conducted in accordance with the Declaration of Helsinki approved by the institutional review board of Kaohsiung Veterans General Hospital (number 20‐CT8‐03(200618‐3)). The informed consent requirement was waived because the data were de-identified.
Early lactate area scores and serial blood lactate levels as prognostic markers for patients with septic shock: a systematic review
Published in Infectious Diseases, 2020
Rozita Khodashahi, Soroush Sarjamee
Although the risk stratification may be better diagnosed by a single initial lactate level in comparison to that by the lactate area score, important data on the effectiveness of resuscitation are obtained by the measurement of serial lactate. In addition, normalization is related to blood lactate levels and improvement of patients with septic shock. Moreover, dynamic changes in lactate levels are indicated by lactate clearance; however, these factors do not provide data regarding the severity of hyperlactatemia. The single initial lactate level is not sufficient for predicting the outcomes of patients with septic shock. Nevertheless, the measurement of serial lactate levels is a strong predictor of mortality among these patients, which emphasizes the importance of the time course of lactate levels in the prediction of the outcomes.
Blood lactate and lactate kinetics as treatment and prognosis markers for tissue hypoperfusion
Published in Acta Clinica Belgica, 2020
Marzia Verhaeghe, Saïd Hachimi-Idrissi
For septic shock however, the relation between L/LK and the patient’s outcome has been repeatedly reported in descriptive [1,4] and clinical studies [9,11–13,22,23]. Other retrospective and prospective studies showed that septic shock can also occur without hyperlactatemia. In a prospective study, the group without hyperlactatemia showed a very low mortality rate (7.9%), which is significantly lower than the mortality rate of the patients with hyperlactatemia (20.9%) [24]. Other retrospective study, also showed a significantly lower mortality rate in patients without hyperlactatemia compared to patients with hyperlactatemia (7.7% vs 42.9%) [25]. These results again suggest that a low L in septic shock patients results in a lower mortality risk. Presence of hyperlactatemia would add information about the severity of the condition [11].