Yang Cong-Shan, Qiu Hai-Bo, Huang Ying-Zi, Xie Jian-Feng, Mo Min, Liu Song-Qiao, Yang Yi
Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, China.
Zhonghua Wai Ke Za Zhi. 2009 May 1;47(9):685-8.
To evaluate the correlation between the lactate in artery blood and lactate clearance rate and prognosis in patients with septic shock in intensive care unit (ICU).
Prospectively studied 221 consecutive patients with septic shock from December 2005 to December 2007, the diagnosis of septic shock was made based on the criteria of 2001 ACCP/SCCM. For inclusion in the study, we required admission of the patients within 24 h of septic shock diagnosed. The criteria for exclusion from the study were an age of less than 18 years, pregnancy, serious inadequacy of liver and renal, needing blood purification, or acidosis result of biguanides drugs, or do-not-resuscitate. The eligible patients assigned to early goal-directed therapy. The 6-, 24- and 72-hour lactate clearance rate were calculated, the relationship between the level of lactate, lactate clearance rate, the APACHE II score, the number of failed organ and the 28-day mortality were evaluated.
One hundred and five patients with septic shock were admitted, 74 male and 31 female, the mean age was 70 +/- 12 years. The 28-day mortality was 54.3%. The average APACHE II score at baseline was 20 +/- 8, the number of failed organs was 3.0 +/- 1.1 and the average concentration of lactate in artery blood at baseline was (3.8 +/- 3.6) mmol/L. Significant differences of the lactate at 0-, 6-, 24- and 72-hour were found between death group and survival group. There were 69 patients whose lactate in artery blood at baseline was > 2 mmol/L, 24 survived. The lactate clearance rate of 6- and 24-hour in survival group were significantly higher than death group (P < 0.01, P < 0.05, respectively), but the lactate clearance rate of 72-hour was not (P > 0.05). By using a multivariate logistic regression analysis, it showed that the lactate clearance rate of 6-hour was the independent predictive factor of survival. The area under the receiver operating characteristic curve (ROC) was 0.564, 0.649, 0.754, 0.784, respectively according to the level of the lactate at 0-, 6-, 24-hour and the 6-hour lactate clearance rate. The cutoff of 6-hour lactate clearance rate was >or= 30.0%, resulting in a sensitivity of 60.0% and a specificity of 77.3%.
Dynamic observation of lactate level is very important for the survival in the patients with septic shock. Patients with elevated lactate and not decreased rapidly have a worse outcome. The 6-hour lactate clearance rate might be the indicator for predicting the prognosis of patients with septic shock.
评估重症监护病房（ICU）中脓毒性休克患者动脉血乳酸水平、乳酸清除率与预后之间的相关性。
前瞻性研究2005年12月至2007年12月期间连续收治的221例脓毒性休克患者，脓毒性休克的诊断依据2001年美国胸科医师学会（ACCP）/危重病医学会（SCCM）标准。纳入本研究的患者需在脓毒性休克诊断后24小时内入院。排除标准为年龄小于18岁、妊娠、严重肝肾功能不全、需要血液净化、因双胍类药物导致酸中毒或放弃复苏。符合条件的患者接受早期目标导向治疗。计算6小时、24小时和72小时的乳酸清除率，评估乳酸水平、乳酸清除率、急性生理与慢性健康状况评分系统（APACHE II）评分、器官功能衰竭数量与28天死亡率之间的关系。
共收治105例脓毒性休克患者，男性74例，女性31例，平均年龄为70±12岁。28天死亡率为54.3%。基线时平均APACHE II评分为20±8，器官功能衰竭数量为3.0±1.1，基线时动脉血乳酸平均浓度为（3.8±3.6）mmol/L。死亡组与存活组在0小时、6小时、24小时和72小时的乳酸水平存在显著差异。69例基线时动脉血乳酸>2 mmol/L的患者中，24例存活。存活组6小时和24小时的乳酸清除率显著高于死亡组（分别为P<0.01，P<0.05），但72小时的乳酸清除率无显著差异（P>0.05）。多因素逻辑回归分析显示，6小时乳酸清除率是存活的独立预测因素。根据0小时、6小时、24小时的乳酸水平及6小时乳酸清除率绘制的受试者工作特征曲线（ROC）下面积分别为0.564、0.649、0.754、0.784。6小时乳酸清除率的截断值为≥30.0%，灵敏度为60.0%，特异度为77.3%。
动态观察乳酸水平对脓毒性休克患者的存活非常重要。乳酸水平升高且下降不迅速的患者预后较差。6小时乳酸清除率可能是预测脓毒性休克患者预后的指标。
