Department of Emergency Medicine and Internal Medicine, Division of Pulmonary/Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
J Crit Care. 2010 Dec;25(4):576-81. doi: 10.1016/j.jcrc.2010.03.003. Epub 2010 Jun 19.
The objective of the study was to determine the prevalence of absolute thiamine deficiency (TD) in critically ill patients with sepsis and to examine the association between thiamine levels and lactic acidosis.
This was a prospective, observational study.
The setting was an urban, tertiary care center with approximately 50,000 emergency department visits per year and intensive care units numbering approximately 50 total beds.
Thirty study patients admitted with clinical suspicion of infection and evidence of tissue hypoperfusion, as defined by a lactic acid level greater than 4 mmol/L or hypotension (systolic blood pressure <90 mm Hg) requiring vasopressor support, were enrolled. A control group of 30 patients presenting to the emergency department with minor emergencies was also enrolled.
There were no interventions.
Plasma thiamine levels were measured at 0, 24, 48, 72, and 162 hours for patients in the study group. Absolute TD was defined as less than or equal to 9 nmol/L derived from established abnormal ranges per Quest laboratory. In the study group, 3 (10%) of 30 had absolute TD upon presentation; and an additional 3 patients (6/30, 20%) developed TD within 72 hours. None of the 30 controls (0/30, 0%) exhibited absolute TD. Of the vasopressor-dependent population, 7.7% (2/26) displayed TD on presentation. For the group overall, there was no correlation between thiamine and lactic acidosis. However, in patients without liver dysfunction, thiamine was statistically significantly negatively correlated with lactic acidosis (r = -.50; P = .02). The relationship between thiamine and lactic acidosis held after multivariable regression analysis controlling for age, sex, and comorbid disease (P < .02).
These preliminary findings indicate that critically ill patients may present with TD or develop this deficiency during their acute illness. We also identified a potential association between thiamine levels and lactic acidosis in patients without significant liver injury.
本研究旨在确定脓毒症危重症患者绝对硫胺素缺乏症（TD）的患病率，并探讨硫胺素水平与乳酸酸中毒之间的关系。
这是一项前瞻性、观察性研究。
该研究在一家城市三级保健中心进行，该中心每年有大约 50000 例急诊就诊，重症监护病房共有约 50 张床位。
30 例因疑似感染且存在组织灌注不足（定义为乳酸水平大于 4mmol/L 或低血压[收缩压<90mmHg]需要血管加压药支持）而入院的患者被纳入研究。还纳入了 30 例因轻微急症就诊于急诊室的对照组患者。
无干预措施。
研究组患者在 0、24、48、72 和 162 小时时测量血浆硫胺素水平。根据 Quest 实验室的既定异常范围，将绝对 TD 定义为小于或等于 9nmol/L。在研究组中，3（10%）例患者在就诊时存在绝对 TD；另有 3 例（6/30，20%）患者在 72 小时内发生 TD。30 例对照组患者（0/30，0%）均无绝对 TD。在依赖血管加压药的患者中，7.7%（2/26）在就诊时存在 TD。对于总体人群，硫胺素与乳酸酸中毒之间无相关性。然而，在无肝功能障碍的患者中，硫胺素与乳酸酸中毒呈显著负相关（r=-.50；P=0.02）。在控制年龄、性别和合并症后，多变量回归分析仍显示硫胺素与乳酸酸中毒之间存在相关性（P<.02）。
这些初步发现表明，危重症患者可能在就诊时存在 TD，或在急性疾病期间发生这种缺乏。我们还发现，在无明显肝损伤的患者中，硫胺素水平与乳酸酸中毒之间存在潜在关联。
