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Aim  The purpose of this subgroup analysis of a Japanese multicenter registry, the Japanese Association for Acute Medicine Sepsis Registry Advanced ( JAAM ‐ SR ‐Advanced), was to identify early outcome indicators for severe sepsis that are useful and more objective than “septic shock.”    Methods  Among 624 patients with severe sepsis registered in  JAAM ‐ SR ‐Advanced, 554 with valid serum lactate data were retrospectively studied. Hypotension before and after fluid resuscitation and the highest lactate values over the initial 24 h were compared for their ability to predict in‐hospital mortality.    Results  Of the study group, 155 (28.0%) patients were non‐survivors and had significantly lower systolic blood pressures and higher lactate peaks. The mortality of 364 patients with initial hypotension was higher than those patients without it (32.7% versus 19.1%,  P  <   0.01). Patients with the worst lactate values ≥4 mmol/L had much higher mortality than other patients ( P  <   0.001). In an attempt to predict outcomes, we combined initial hypotension and the worst lactate values. The patient group with initial hypotension and the worst lactate values ≥4 mmol/L (183 patients, 33.0%) had a significantly higher mortality rate of 48.6% than the other groups ( P  <   0.01).    Conclusion  The novel combined criterion of initial hypotension and the worst lactate values ≥4 mmol/L within the initial 24 h is potentially useful as a single outcome predictor for severe sepsis.

acute medicine and surgery

Early evaluation of severity in patients with severe sepsis: a comparison with “septic shock” — subgroup analysis of the Japanese Association for Acute Medicine Sepsis Registry ( JAAM ‐ SR )