Vroonhof Karen, van Solinge Wouter W, Rovers Maroeska M, Huisman Albert
Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Utrecht, The Netherlands.
Clin Chem Lab Med. 2005;43(5):536-41. doi: 10.1515/CCLM.2005.093.
The objective of this study was to relate multiple laboratory results of initial blood gas analysis in patients visiting the emergency department to mortality. A total of 1806 adult patients visiting the emergency department for any reason, who underwent blood gas analysis, were included in this study. The results of nine laboratory parameters (ionised calcium, potassium, sodium, glucose, lactate, pH, pCO(2), pO(2) and saturation) were related to mortality. Comparison of the means of survivors' and non-survivors' age, pH, p(O)2 , glucose and lactate showed relevant differences (p < or = 0.001). When dividing the group of patients into quintiles, hypo- and hyperkalaemia (<3.6 or >4.3 mmol/L), hypocalcaemia (<1.12 mmol/L), hyperglycaemia (> 10.6 mmol/L), hyperlactataemia (>2.9 mmol/L) and acidosis (pH < 7.34) were all related to high mortality in comparison to the quintile with the lowest mortality (p < 0.0001). Interestingly, even within the reference range for lactate and ionised calcium, there was an increased risk of mortality, so these reference ranges should be interpreted with care. Glucose and lactate have additional clinical value, but are not always requested. Therefore, glucose and lactate should be routinely added to a blood gas request. Our study shows differences in mortality for laboratory parameters in patients visiting the emergency department, irrespective of the underlying pathology.
本研究的目的是将急诊科患者初次血气分析的多项实验室结果与死亡率相关联。共有1806名因任何原因前往急诊科且接受了血气分析的成年患者纳入本研究。九个实验室参数（离子钙、钾、钠、葡萄糖、乳酸、pH值、二氧化碳分压、氧分压和饱和度）的结果与死亡率相关。对幸存者和非幸存者的年龄、pH值、氧分压、葡萄糖和乳酸的均值比较显示出显著差异（p≤0.001）。将患者组分为五分位数时，低钾血症和高钾血症（<3.6或>4.3 mmol/L）、低钙血症（<1.12 mmol/L）、高血糖症（>10.6 mmol/L）、高乳酸血症（>2.9 mmol/L）和酸中毒（pH<7.34）与死亡率最低的五分位数相比，均与高死亡率相关（p<0.0001）。有趣的是，即使在乳酸和离子钙的参考范围内，死亡率风险也会增加，因此这些参考范围的解释应谨慎。葡萄糖和乳酸具有额外的临床价值，但并非总是被要求检测。因此，葡萄糖和乳酸应常规添加到血气分析申请中。我们的研究表明，急诊科患者的实验室参数在死亡率方面存在差异，无论其潜在病理状况如何。
