Development and external validation of a parsimonious lactate-to-diastolic blood pressure ratio model for 28-day mortality risk stratification in septic shock: a retrospective two-cohort study - Scorecard - MDSpire
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Development and external validation of a parsimonious lactate-to-diastolic blood pressure ratio model for 28-day mortality risk stratification in septic shock: a retrospective two-cohort study
Clinical Scorecard: Creation and external assessment of a simplified model utilizing the lactate-to-diastolic blood pressure ratio for predicting 28-day mortality risk in patients with septic shock: a retrospective analysis involving two cohorts
At a Glance
Category
Detail
Condition
Septic Shock
Key Mechanisms
Lactate-to-diastolic blood pressure ratio (LDR) as a predictor of mortality
Target Population
Patients with septic shock requiring invasive arterial monitoring
Care Setting
Intensive Care Unit (ICU)
Key Highlights
LDR × 100 predicts 28-day mortality in septic shock patients.
Mortality rates were 29.7% in the development cohort and 26.0% in the validation cohort.
LDR × 100 showed AUCs of 0.726 and 0.714 for discrimination in the two cohorts.
Calibration drift indicates the need for local recalibration of risk estimates.
LDR is intended for use in patients with invasive monitoring, not general septic shock patients.
Guideline-Based Recommendations
Diagnosis
Use Sepsis-3 criteria for diagnosing septic shock.
Management
Initiate continuous vasopressor infusion based on lactate levels and diastolic blood pressure.
Monitoring & Follow-up
Monitor lactate and invasive diastolic blood pressure to calculate LDR.
Risks
Patients with lactate <4.0 mmol/L and DBP <50 mmHg have higher mortality.
Patient & Prescribing Data
Adults meeting Sepsis-3 criteria for septic shock.
LDR provides a simple bedside marker for risk stratification at vasopressor initiation.
Clinical Best Practices
Utilize LDR as a complementary assessment tool in the lactate gray zone.
Ensure invasive arterial monitoring is in place before applying LDR.
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