Department of Emergency Medicine, Loma Linda University, Loma Linda, CA.
J Inflamm (Lond). 2010 Jan 28;7:6. doi: 10.1186/1476-9255-7-6.
Lactate clearance, a surrogate for the magnitude and duration of global tissue hypoxia, is used diagnostically, therapeutically and prognostically. This study examined the association of early lactate clearance with selected inflammatory, coagulation, apoptosis response biomarkers and organ dysfunction scores in severe sepsis and septic shock.
Measurements of serum arterial lactate, biomarkers (interleukin-1 receptor antagonist, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor-alpha, intercellular adhesion molecule-1, high mobility group box-1, D-Dimer and caspase-3), and organ dysfunction scores (Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Multiple Organ Dysfunction Score, and Sequential Organ Failure Assessment) were obtained in conjunction with a prospective, randomized study examining early goal-directed therapy in severe sepsis and septic shock patients presenting to the emergency department (ED). Lactate clearance was defined as the percent change in lactate levels after six hours from a baseline measurement in the ED.
Two-hundred and twenty patients, age 65.0 +/- 17.1 years, were examined, with an overall lactate clearance of 35.5 +/- 43.1% and in-hospital mortality rate of 35.0%. Patients were divided into four quartiles of lactate clearance, -24.3 +/- 42.3, 30.1 +/- 7.5, 53.4 +/- 6.6, and 75.1 +/- 7.1%, respectively (p < 0.01). The mean levels of all biomarkers and organ dysfunction scores over 72 hours were significantly lower with higher lactate clearance quartiles (p < 0.01). There was a significant decreased in-hospital, 28-day, and 60-day mortality in the higher lactate clearance quartiles (p < 0.01).
Early lactate clearance as a surrogate for the resolution of global tissue hypoxia is significantly associated with decreased levels of biomarkers, improvement in organ dysfunction and outcome in severe sepsis and septic shock.
乳酸清除率是衡量组织缺氧程度和持续时间的替代指标，在诊断、治疗和预后方面都有应用。本研究旨在探讨严重脓毒症和感染性休克患者早期乳酸清除率与选定的炎症、凝血、细胞凋亡反应生物标志物和器官功能障碍评分之间的关系。
在一项前瞻性、随机研究中，对急诊科就诊的严重脓毒症和感染性休克患者进行早期目标导向治疗，同时测量血清动脉乳酸、生物标志物（白细胞介素-1 受体拮抗剂、白细胞介素-6、白细胞介素-8、白细胞介素-10、肿瘤坏死因子-α、细胞间黏附分子-1、高迁移率族蛋白-1、D-二聚体和半胱天冬酶-3）和器官功能障碍评分（急性生理学和慢性健康评估 II、简化急性生理学评分 II、多器官功能障碍评分和序贯器官衰竭评估）。乳酸清除率定义为急诊科基线测量后 6 小时内乳酸水平的百分比变化。
共检查了 220 例年龄 65.0 ± 17.1 岁的患者，总体乳酸清除率为 35.5 ± 43.1%，住院死亡率为 35.0%。患者分为乳酸清除率的四个四分位组，分别为-24.3 ± 42.3、30.1 ± 7.5、53.4 ± 6.6 和 75.1 ± 7.1%（p < 0.01）。随着乳酸清除率四分位的升高，所有生物标志物和器官功能障碍评分在 72 小时内的平均水平显著降低（p < 0.01）。在更高的乳酸清除率四分位中，住院、28 天和 60 天死亡率显著降低（p < 0.01）。
作为组织缺氧缓解的替代指标，早期乳酸清除率与严重脓毒症和感染性休克患者生物标志物水平降低、器官功能障碍改善和预后改善显著相关。
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