Blood Lactate Level versus Cytokine Levels as Prognostic Indictors in Septic Shock

Abstract

Sepsis refers to the systemic response to serious infection. When this syndrome results in hypotension or multiple organ system failure, the condition is called septic shock. Bacteria is often present in septic patients and has been associated with a more rapid progression to shock. The presence of circulating bacteria or bacterial products . such as endotoxin can lead to the systemic release of endogenous mediators which can produce profound physiologic effects on vasculature and organ systems.

Clinical evaluation during the course of treatment of septic shock is very important but alone may not be sufficient. Many monitors are recommended during the course of treatment such as hemodynamic variables, gastric intramucosel pH, scoring systems, blood lactate level, cytokine level and endotoxin serum concentration.

Septic is characterized by dramatic disturbances in microvascular control with profound changes in cardiac output distribution. Inadequate tissue perfusion during shock states results in the development of anaerobic metabolism with accumulation of lactate in the blood. Lactate levels have been used as marker of cellular injury and the severity of lactic acidosis has been correlated with the severity of the shock state.

Tumor necrosis factor-a and intuleukin-6 are considered central mediators of sepsis in humans. High initial serum levels of TNF-a and IL-6 have been correlated with the severity of the sepsis and the mortality in patients with severe infection. The persistence of elevated levels of TNF-a and IL-6 in the blood of the patients