Urine Output as a Surrogate for Adequate Perfusion During Septic Shock Resuscitation: A Prospective Cohort Study
DOI:
https://doi.org/10.33192/smj.v78i8.280923Keywords:
Septic shock, urine output, serum lactate, tissue perfusion, Cardiopulmonary resuscitationAbstract
Objective: Septic shock resuscitation targets hemodynamic stabilization (mean arterial pressure 65 mmHg) and tissue perfusion, defined by lactate < 2 mmol/L or lactate clearance > 10%. Because urine output is widely used as an organ perfusion goal, we examined its behavior during resuscitation and its association with lactate kinetics and outcomes.
Materials and Methods: We conducted a prospective cohort study of patients with intact urine flow during resuscitation. Serum lactate was measured at resuscitation start and at hemodynamic stabilization, and hourly urine flow was recorded. The primary outcome was survival without organ support at 28 days after septic shock diagnosis. We assessed correlations between urine flow and lactate clearance at stabilization.
Results: From January to July 2024, 95 patients were screened; 20 were excluded. The remaining 75 achieved hemodynamic stabilization within 12 hours, and all but 2 met tissue oxygenation goals regardless of urine flow rate. The proportion with urine output < 0.5 mL/kg/hour did not differ between survivors and the death/organ support group. In multivariable analysis, urine output at stabilization < 0.4 mL/hour was not associated with unfavorable outcomes, whereas lactate at stabilization > 3 mmol/L was associated with in-hospital mortality and organ support.
Conclusions: During septic shock resuscitation, intact urine flow at hemodynamic restoration may serve as a surrogate of adequate tissue perfusion when infection is controlled. However, lactate remains a key milestone for confirming perfusion restoration.
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