Moore Christopher C, Jacob Shevin T, Pinkerton Relana, Meya David B, Mayanja-Kizza Harriet, Reynolds Steven J, Scheld W Michael
Department of Internal Medicine, Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, VA 22908, USA.
Clin Infect Dis. 2008 Jan 15;46(2):215-22. doi: 10.1086/524665.
Prediction of mortality may improve management and outcomes of patients with sepsis in resource-limited settings. Therefore, we evaluated the ability of a hand-held portable whole-blood lactate (PWBL) analyzer to predict mortality of patients who are admitted to the hospital with severe sepsis.
A prospective observational study enrolled 253 patients at a national referral hospital in Uganda. Inclusion criteria required (1) >or=2 systemic inflammatory response syndrome criteria or thermodysregulation, (2) hypotension, and (3) suspected infection. A subset of 72 patients had PWBL and standard laboratory serum lactate measured. The primary measured outcome was in-hospital mortality.
Fifty-nine (81.9%) of 72 evaluated patients were infected with human immunodeficiency virus type 1. The in-hospital mortality rate was 25.7% (18 of 70), and the in- and outpatient mortality at 30 days was 41.6% (30 of 72). PWBL was positively associated with in-hospital but not outpatient mortality (P=.001). The receiver operating characteristic area under the curve for PWBL was 0.81 (P=.081). The optimal PWBL concentration for predicting in-hospital mortality (sensitivity, 88.3%; specificity, 71.2%) was >or=4.0 mmol/L. Patients with a PWBL concentration >or=4.0 mmol/L died while in the hospital substantially more often (50.0%) than did those with a PWBL concentration <4.0 mmol/L (7.5%) (odds ratio, 12.3; 95% confidence interval, 3.5-48.9; [P=.001). Standard laboratory serum lactate results were inconsistent and less predictive of mortality than were those of PWBL in a multiple logistic regression model.
A PWBL concentration >or=4.0 mmol/L predicts with 81% accuracy a 7-fold higher mortality of patients with sepsis than does a PWBL concentration <4.0 mmol/L. PWBL testing would be useful in places where clinical decisions are limited by lack of laboratory infrastructure and poor reliability.
在资源有限的环境中，预测死亡率可能会改善脓毒症患者的管理和预后。因此，我们评估了手持式便携式全血乳酸（PWBL）分析仪预测因严重脓毒症入院患者死亡率的能力。
一项前瞻性观察性研究在乌干达的一家国家级转诊医院纳入了253例患者。纳入标准要求：（1）≥2条全身炎症反应综合征标准或体温调节异常；（2）低血压；（3）疑似感染。72例患者的一个亚组同时进行了PWBL和标准实验室血清乳酸检测。主要测量结局为住院死亡率。
72例评估患者中有59例（81.9%）感染了1型人类免疫缺陷病毒。住院死亡率为25.7%（70例中的18例），30天内的住院和门诊死亡率为41.6%（72例中的30例）。PWBL与住院死亡率呈正相关，但与门诊死亡率无关（P = 0.001）。PWBL的曲线下受试者工作特征面积为0.81（P = 0.081）。预测住院死亡率的最佳PWBL浓度（敏感性为88.3%；特异性为71.2%）≥4.0 mmol/L。PWBL浓度≥4.0 mmol/L的患者在医院死亡的频率（50.0%）显著高于PWBL浓度<4.0 mmol/L的患者（7.5%）（优势比为12.3；95%置信区间为3.5 - 48.9；[P = 0.001]）。在多元逻辑回归模型中，标准实验室血清乳酸结果不一致，且对死亡率的预测性低于PWBL。
PWBL浓度≥4.0 mmol/L预测脓毒症患者死亡率的准确率为81%，比PWBL浓度<4.0 mmol/L的患者死亡率高7倍。在临床决策因缺乏实验室基础设施和可靠性差而受限的地方，PWBL检测将很有用。
