Chawla Lakhmir S, Shih Shirley, Davison Danielle, Junker Christopher, Seneff Michael G
Department of Critical Care Medicine and Anesthesiology, George Washington University Medical Center, Washington, DC, USA.
BMC Emerg Med. 2008 Dec 16;8:18. doi: 10.1186/1471-227X-8-18.
Base deficit (BD), anion gap (AG), and albumin corrected anion gap (ACAG) are used by clinicians to assess the presence or absence of hyperlactatemia (HL). We set out to determine if these tools can diagnose the presence of HL using cotemporaneous samples.
We conducted a chart review of ICU patients who had cotemporaneous arterial blood gas, serum chemistry, serum albumin (Alb) and lactate(Lac) levels measured from the same sample. We assessed the capacity of AG, BD, and ACAG to diagnose HL and severe hyperlactatemia (SHL). HL was defined as Lac > 2.5 mmol/L. SHL was defined as a Lac of > 4.0 mmol/L.
From 143 patients we identified 497 series of lab values that met our study criteria. Mean age was 62.2 +/- 15.7 years. Mean Lac was 2.11 +/- 2.6 mmol/L, mean AG was 9.0 +/- 5.1, mean ACAG was 14.1 +/- 3.8, mean BD was 1.50 +/- 5.4. The area under the curve for the ROC for BD, AG, and ACAG to diagnose HL were 0.79, 0.70, and 0.72, respectively.
AG and BD failed to reliably detect the presence of clinically significant hyperlactatemia. Under idealized conditions, ACAG has the capacity to rule out the presence of hyperlactatemia. Lac levels should be obtained routinely in all patients admitted to the ICU in whom the possibility of shock/hypoperfusion is being considered. If an AG assessment is required in the ICU, it must be corrected for albumin for there to be sufficient diagnostic utility.
临床医生使用碱缺失（BD）、阴离子间隙（AG）和白蛋白校正阴离子间隙（ACAG）来评估高乳酸血症（HL）的存在与否。我们旨在确定这些工具能否使用同期样本诊断HL的存在。
我们对ICU患者进行了病历回顾，这些患者的同期动脉血气、血清化学、血清白蛋白（Alb）和乳酸（Lac）水平是从同一样本中测量的。我们评估了AG、BD和ACAG诊断HL和严重高乳酸血症（SHL）的能力。HL定义为Lac>2.5 mmol/L。SHL定义为Lac>4.0 mmol/L。
从143例患者中，我们确定了497组符合我们研究标准的实验室值。平均年龄为62.2±15.7岁。平均Lac为2.11±2.6 mmol/L，平均AG为9.0±5.1，平均ACAG为14.1±3.8，平均BD为1.50±5.4。BD、AG和ACAG诊断HL的ROC曲线下面积分别为0.79、0.70和0.72。
AG和BD未能可靠地检测出临床上显著的高乳酸血症的存在。在理想条件下，ACAG有能力排除高乳酸血症的存在。对于所有因考虑休克/低灌注可能性而入住ICU的患者，应常规检测Lac水平。如果在ICU需要进行AG评估，必须针对白蛋白进行校正，以便有足够的诊断效用。
