The prognostic importance of tissue perfusion parameters and lactate clearance in early shock treatment in patients diagnosed with shock in the emergency department

Objective: In the emergency department, it is very important to evaluate the response of the shock patient to the treatment, regardless of the etiology. Therefore, we aimed to investigate the prognostic significance of tissue perfusion parameters, especially lactate clearance, and their relationship with short-term mortality in patients diagnosed with shock in the emergency department. Material and Method: This study was conducted prospectively between January 2020 and January 2022 in Çukurova University Faculty of Medicine, Department of Emergency Medicine, after approval from the Çukurova University Ethics Committee. Ninety-one patients over the age of 18 who were diagnosed with shock in the emergency department with different etiologic causes were included in the study. These patients; Age, gender, complaints, vital signs, current diseases, ultrasonographic data, laboratory values and perfusion parameters were recorded and lactate clearance was calculated. The outcome of the patients, hospitalization, mortality in the first 24 hours in the emergency department, and mortality on the 15th and 30th days were evaluated. Results: Fifty-four percent point nine (n=50) of the patients were male and the mean age was 60.8±19 years. Of the patients, 65.9% (n=60) had septic shock, 13.2% (n=12) had cardiogenic shock, 7.7% (n=7) had hemorrhagic shock, 6.6% ( n=6) had hypovolemic shock, 4.4% (n=4) had shock due to poisoning, 1.1% (n=1) had shock due to adrenal insufficiency and 1.1% (n=1) had anaphylactic shock. The proportion of patients who were positive for COVID-19 was 13.2% (n=12). It was observed that 72.5% (n=66) of the patients were admitted to the intensive care unit and 11% (n=10) to the wards. The mean hospital stay was 8±6.1 days. The mortality of the patients diagnosed with shock was 5.5% (n=5) in the first 24 hours, 39.6% (n=36) within 15 days, and 47.3% (n=43) within 30 days. The relationship between the patients' mortality on the first day, 15th and 30th days and their admission vital signs was examined, and it was determined that the patients with high respiratory rate and low Glasgow coma score at the first admission had a high mortality. (p=0.001). The first day, 15th and 30th day mortality and laboratory parameters of the patients were compared and it was determined that the neutrophil/lymphocyte ratio, ALT, AST, LDH, BUN, ferritin, CKMB, troponin, D-Dimer and proclacytonin values were statistically significantly higher. (P<0.05, P<0.001 were considered significant.) Similar mean lactate clearance values were observed in septic shock and cardiogenic shock (17.9±38.9 and 17.1±28.8, respectively). When the other perfusion parameters of the patients were examined, it was determined that low PH and HCO3 at the time of admission, high lactate and high base deficit were statistically associated with mortality. Conclusion: It is thought that calculating lactate clearance in patients diagnosed with shock in the emergency department enables the evaluation of response to treatment and can be used as a strong early prognostic indicator. Key Words: Emergency department, Lactate clearance, Mortality, Perfusion parameters, Shock