Early Clearance of Lactate and Its Outcome in Septic Patients

Sepsis persists as a major cause of in-hospital mortality, with the highest burden in low- and middle-income countries. Early lactate clearance is proposed as a dynamic, low-cost biomarker of tissue perfusion, yet locally generated evidence from Pakistan is scarce. Objectives: To evaluate the frequency of early lactate clearance and its association with 30-day all-cause mortality and multiorgan failure in adults admitted with sepsis. Methods: This prospective cohort study with a 30-day follow-up was conducted in the Department of General Medicine, Jinnah Postgraduate Medical Centre, Karachi (14 October 2025 and 14 January 2026) after ethical approval. A total of 195 adults aged 18–65 years with Sepsis-3-defined sepsis and admission venous lactate >4 mmol/L were enrolled by consecutive sampling. Early lactate clearance was defined as a ≥10% reduction in venous lactate at 6 hours. Outcomes were SOFA-defined multiorgan failure and 30-day mortality. Continuous variables were summarized as median (IQR) after Shapiro-Wilk testing; binary logistic regression & survival analysis were performed. Results: Early lactate clearance occurred in 106/195 (54.4%) patients. Thirty-day mortality was significantly lower with clearance than without (12.3% vs 24.7%; OR 0.43, 95% CI 0.20–0.91; p=0.024), persisting after adjustment (aOR 0.43, 95% CI 0.20–0.94; p=0.035). Multiorgan failure did not differ significantly (17.0% vs 22.5%; OR 0.71, 95% CI 0.35–1.44; p=0.335). Conclusions: Early lactate clearance was associated with significantly lower 30-day mortality in this underpowered exploratory analysis; however, these findings require confirmation in larger adequately powered studies.