Lactic acid as an adjuvant marker in pregnancy-associated sepsis

Abstract

Background. Lactic acid level is one index which is currently actively researched for its role in pregnancy-associated sepsis (PAS). We aimed to quantify the severity of PAS using lactic acid levels.

Methods. All pregnant, post-abortal (2 weeks) and postpartum women (up to 6 weeks) with clinical sepsis were enrolled as per systemic inflammatory response syndrome criteria, and lactic acid levels were estimated at admission. Severe PAS was defined as one or more organ dysfunctions due to sepsis. The severity of obstetric sepsis was graded according to number of organ failures.

Results. There were 42 patients with non-severe PAS, and 58 with severe PAS. The ≥4 mmol/L lactic acid threshold had 88.10% specificity and 37.93% sensitivity for detection of severe PAS. A significant difference (p=0.006) was found between lactic acid levels (mean (standard deviation (SD)) in cases with single OF (n=24; 3.02 (0.92) mmol/L) v. multi-organ failure (n=34; 3.70 (0.81) mmol/L). The mean (SD) lactic acid levels (3.76 (0.97) mmol/L) with any type of culture-positive PAS cases (n=35) were significantly higher than in culture-negative PAS cases (2.95 (0.98); p=0.0001).

Conclusions. Lactic acid level ≥4 mmol/L had reasonable specificity for severity and culture positivity in PAS. A serum lactic acid level ≥3 mmol/L was associated with more number of organ failures.