Dear Editor, Sepsis represents a global problem with high economic burden for health care systems. Since 2002, the Surviving Sepsis Campaign has recommended early quantitative resuscitation for patients with severe sepsis and septic shock with a recent update [1]. However, the optimal goals for quantitative resuscitation remain uncertain. Lactate clearance, defined by the change of lactate levels between two points in time, as a more rapid and less costly parameter, has the potential to be such a promising goal for quantitative resuscitation. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of early lactate clearance-guided therapy on mortality and other outcomes in patients with sepsis.

We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials to identify RCTs that evaluated the effect of early lactate clearance-guided therapy on clinical outcomes in adults with sepsis. The search terms used were ‘‘lactate clearance’’, and ‘‘sepsis’’, or ‘‘severe sepsis’’or ‘‘septic shock’’. We used the Cochrane collaboration tool to assess risk of bias, and the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to evaluate the quality of evidence. The primary outcome was all-cause mortality. Secondary outcomes included length of hospital stay and length of intensive care unit (ICU) stay. We calculated risk ratios (RRs) or mean differences (MDs) and 95% confidence intervals (CIs) using a randomeffects model. A two-tailed p value less than 0.05 was considered a significant level except for where a certain p value has been given. All statistical analyses were performed using RevMan 5.2 (Nordic Cochrane Centre). We conducted trial sequential analysis (TSA) using a diversityadjusted required information size calculated from an alpha error of 0.05, a beta error of 0.20, a control