Jansen Tim C, van Bommel Jasper, Mulder Paul G, Lima Alexandre P, van der Hoven Ben, Rommes Johannes H, Snellen Ferdinand T F, Bakker Jan
Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
J Trauma. 2009 Feb;66(2):377-85. doi: 10.1097/TA.0b013e3181648e2f.
Hyperlactatemia and its reduction after admission in the intensive care unit (ICU) have been related to survival. Because it is unknown whether this equally applies to different groups of critically ill patients, we compared the prognostic value of repeated lactate levels (a) in septic patients versus patients with hemorrhage or other conditions generally associated with low-oxygen transport (LT) (b) in hemodynamically stable versus unstable patients.
In this prospective observational two-center study (n = 394 patients), blood lactate levels at admission to the ICU (Lac(T0)) and the reduction of lactate levels from T = 0 to T = 12 hours (DeltaLac(T0-12)) and from T = 12 to T = 24 hours (DeltaLac(T12-24)), were related to in-hospital mortality.
Reduction of lactate was associated with a lower mortality only in the sepsis group (DeltaLac(T0-12): hazard ratio [HR] 0.34, p = 0.004 and DeltaLac(T12-24): HR 0.24, p = 0.003), but not in the LT group (DeltaLac(T0-12); HR 0.78, p = 0.52 and DeltaLac(T12-24); HR 1.30, p = 0.61). The prognostic values of Lac(T0), DeltaLac(T0-12), and DeltaLac(T12-24) were similar in hemodynamically stable and unstable patients (p = 0.43).
Regardless of the hemodynamic status, lactate reduction during the first 24 hours of ICU stay is associated with improved outcome only in septic patients, but not in patients with hemorrhage or other conditions generally associated with LT. We hypothesize that in this particular group a reduction in lactate is not associated with improved outcome due to irreversible damage at ICU admission.
高乳酸血症及其在重症监护病房（ICU）入院后的降低情况与生存率相关。由于尚不清楚这是否同样适用于不同组的重症患者，我们比较了重复乳酸水平的预后价值：（a）脓毒症患者与出血或其他通常与低氧输送（LT）相关疾病的患者；（b）血流动力学稳定与不稳定的患者。
在这项前瞻性观察性双中心研究（n = 394例患者）中，ICU入院时的血乳酸水平（Lac(T0)）以及乳酸水平从T = 0至T = 12小时（ΔLac(T0 - 12)）和从T = 12至T = 24小时（ΔLac(T12 - 24)）的降低情况与住院死亡率相关。
仅在脓毒症组中，乳酸降低与较低死亡率相关（ΔLac(T0 - 12)：风险比[HR] 0.34，p = 0.004；ΔLac(T12 - 24)：HR 0.24，p = 0.003），而在LT组中则不然（ΔLac(T0 - 12)；HR 0.78，p = 0.52；ΔLac(T12 - 24)；HR 1.30，p = 0.61）。在血流动力学稳定和不稳定的患者中，Lac(T0)、ΔLac(T0 - 12)和ΔLac(T12 - 24)的预后价值相似（p = 0.43）。
无论血流动力学状态如何，ICU住院的前24小时内乳酸降低仅与脓毒症患者的预后改善相关，而与出血或其他通常与LT相关疾病的患者无关。我们推测，在这一特定组中，由于ICU入院时的不可逆损伤，乳酸降低与预后改善无关。
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