New research has revealed that a 10% lactate clearance threshold is a stronger predictor of in-hospital mortality for emergency department patients with sepsis or septic shock than PCT clearance. Although an optimal procalcitonin clearance (PCTc) cutoff of 23.1% was identified, it lacked statistical significance for survival. The study was published in the Frontiers in Medicine journal by Razan D. and colleagues.
This retrospective cohort series included 574 adult patients with sepsis or septic shock presenting to a tertiary care emergency department (ED) in Lebanon between November 2018 and March 2024. Data collection included patient demographics, comorbidities, therapeutic interventions, and serial biomarker readings, including procalcitonin and lactate. The clearance rates were calculated by the percentage change between the initial and follow-up readings, and lactate clearance was considered positive if it exceeded 10%. The main outcome measure was in-hospital mortality, while secondary outcomes included ED, ICU, and overall hospital length of stay. ROC curves were generated to assess prognostic accuracy, whereas multivariable logistic regression examined associations between mortality and biomarker clearance.
Results
The mean age of the study population was 71.4 ± 16.5 years, with a male preponderance of 55.4%.
An optimum cutoff for PCTc was 23.1% which had a high sensitivity of 94% but a very low specificity of 7%.
Patients with lactate clearance >10% demonstrated lower prevalence for chronic kidney disease, p=0.006; congestive heart failure, p=0.02; and chronic obstructive pulmonary disease, p=0.04.
Mortality was significantly associated with lactate clearance >10%, p=0.045, whereas no relation was found with PCTc, p=0.65.
The AUCs showed limited predictive value for all biomarkers: lactate clearance AUC 0.40 (95% CI: 0.34–0.45), PCTc AUC 0.39 (95% CI: 0.33–0.45), and neutrophil-to-lymphocyte ratio (NLR) AUC 0.51 (95% CI: 0.46–0.56), with statistically significant differences among AUCs (p<0.001).
In the multivariable logistic regression, lactate clearance was borderline associated with mortality (OR 0.66, 95% CI: 0.42–1.04, p=0.07), while PCTc had no significant association with mortality (OR 1.13, 95% CI: 0.43–2.95, p=0.81).
The use of vasopressors decreased mortality, while steroid treatment increased the odds of death in the hospital. Compared with procalcitonin clearance, lactate clearance has proven to be more indicative of in-hospital mortality at a 10% cutoff in patients with sepsis and septic shock. While the optimal PCTc cutoff was determined to be 23.1%, no significant relation to survival could be found.
Reference:
Diab, R., Bou Chebl, R., Barmo, N., Siblini, R., Makki, M., Tamim, H., & Abou Dagher, G. (2025). Prognostic utility of procalcitonin and lactate clearance for in-hospital mortality in sepsis. Frontiers in Medicine, 12(1679297). https://doi.org/10.3389/fmed.2025.1679297
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