Cardinal Fernández Pablo Alejandro, Olano Estela, Acosta Clotilde, Bertullo Hugo, Albornoz Henry, Bagnulo Homero
Centro Asistencial del Síndicato Médico del Uruguay, Montevideo, Uruguay.
Med Intensiva. 2009 May;33(4):166-70. doi: 10.1016/s0210-5691(09)71212-4.
Analyze the clinical usefulness of lactate clearance (CL6) immediately after admission to the intensive care unit (ICU) in the first 6 hours.
Surgical-ICU. Centro de Asistencia del Síndicato Médico of Uruguay.
Prospective, analytic and observational study performed between December 1, 2004 and March 31, 2006 in patients over 18 years whose arterial lactate level is higher than 2 mEq/l on admission to the ICU. Lactate clearance (CL6) was defined as the quotient between admissions (L0) minus the six hour lactate level (L6) divided by the admission lactate level. Sensitivity, specificity, positive and negative prognostic value for different CL6 cutoff were analyzed. The optimal CL6 was considered as the cutoff with the highest sum of sensitivity plus specificity.
One hundred and eight patients were included; 64 patients died (mortality intra-ICU 59.3%). ICU mortality related variables, identified by Cox regression analysis, were CL6 (HR=0.458; CI 95%, 0.239-0.876), L0 (HR=1.16; CI 95%, 1.033-1.303) and SAPSII (HR=1.019; CI 95%, 1.006-1.034). A CL6 equal to or lower than 0.4 was considered as optimal cutoff with a positive prognostic value of 74% and negative prognostic value of 61%. It was also associated with lower survival adjusted by the SAPSII value and L0.
In critically ill surgical patients, whose CL6 on admission was over 2 mEq/l, lactate clearance in the first six hours could be useful to predict the ICU outcome.
分析入住重症监护病房（ICU）后最初6小时内乳酸清除率（CL6）的临床实用性。
外科ICU。乌拉圭医学工会援助中心。
2004年12月1日至2006年3月31日期间，对18岁以上、入住ICU时动脉血乳酸水平高于2 mEq/L的患者进行的前瞻性、分析性和观察性研究。乳酸清除率（CL6）定义为入院时乳酸水平（L0）减去6小时后乳酸水平（L6），再除以入院时乳酸水平所得的商。分析了不同CL6临界值的敏感性、特异性、阳性和阴性预后价值。将敏感性加特异性之和最高的临界值视为最佳CL6。
纳入108例患者；64例死亡（ICU内死亡率59.3%）。通过Cox回归分析确定的与ICU死亡率相关的变量为CL6（HR = 0.458；95%置信区间，0.239 - 0.876）、L0（HR = 1.16；95%置信区间，1.033 - 1.303）和SAPSII（HR = 1.019；95%置信区间，1.006 - 1.034）。CL6等于或低于0.4被视为最佳临界值，阳性预后价值为74%，阴性预后价值为61%。它还与经SAPSII值和L0调整后的较低生存率相关。
对于入院时CL6超过2 mEq/L的重症外科患者，最初6小时内的乳酸清除率可能有助于预测ICU结局。
