重症监护病房患者入院时血清乳酸浓度的预后价值

Prognostic value of admission serum lactate concentrations in intensive care unit patients.

作者信息

Soliman H M, Vincent J-L

机构信息

Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium.

出版信息

Acta Clin Belg. 2010 May-Jun;65(3):176-81. doi: 10.1179/acb.2010.037.

DOI:10.1179/acb.2010.037

PMID:20669785

Abstract

BACKGROUND

Although blood lactate concentrations have an established prognostic value in circulatory shock or after cardiac arrest, their relationship with morbidity and length of stay in general intensive care unit (ICU) populations has not been well defined.

METHODS

This study included all 433 patients (246 surgical and 187 medical) consecutively admitted to the Department of medico-surgical intensive care. Hyperlactataemia was defined as a serum lactate concentration > or = 2 mEq/l.

RESULTS

On admission, 195 patients (45%) had hyperlactataemia. Hyperlactataemic patients had higher Acute Physiology and Chronic Health Evaluation (APACHE) II (13.3 +/- 6.9 vs 10.0 +/- 5.2) and Sequential Organ Failure Assessment (SOFA) (5.3 +/- 3.3 vs 3.3 +/- 2.3) scores than patients with normal lactate concentrations (both p < 0.01). There was no overall difference in length of ICU stay (LOS) between the two groups but survivors in the hyperlactataemic group had a longer LOS than survivors in the normal lactate group, whereas hyperlactataemic non-survivors had a shorter LOS than normal lactate non-survivors. Mortality was 9% in patients with normal lactate concentrations and 23% in hyperlactataemic patients. The mortality rate increased with increasing lactate concentrations, from 17% in patients with lactate concentrations from 2-4 mEq/l to 64% in those with concentrations more than 8 mEq/l. Non-survivors had higher lactate concentrations than survivors on admission, and after 24 and 48 hours. Risk factors for developing hyperlactataemia that were present on admission were SOFA score > 5, mean arterial blood pressure less than 70 mmHg, blood sugar greater than 110 mg/dl, and current use of vasopressors.

CONCLUSIONS

Our study documents a direct relationship between the serum lactate level on ICU admission and not only the risk of death in ICU but also the length of ICU stay. Hyperlactataemic survivors have a longer LOS and non-survivors a shorter LOS than normal lactate survivors and non-survivors, respectively.

摘要

背景

尽管血乳酸浓度在循环性休克或心脏骤停后具有既定的预后价值，但其与普通重症监护病房（ICU）患者的发病率和住院时间的关系尚未明确界定。

方法

本研究纳入了连续入住外科重症监护科的所有433例患者（246例外科患者和187例内科患者）。高乳酸血症定义为血清乳酸浓度≥2 mEq/L。

结果

入院时，195例患者（45%）存在高乳酸血症。高乳酸血症患者的急性生理与慢性健康状况评分系统（APACHE）II（13.3±6.9对10.0±5.2）和序贯器官衰竭评估（SOFA）（5.3±3.3对3.3±2.3）评分高于乳酸浓度正常的患者（均p<0.01）。两组患者的ICU住院时间（LOS）无总体差异，但高乳酸血症组的存活者比正常乳酸组的存活者住院时间更长，而高乳酸血症的非存活者比正常乳酸的非存活者住院时间更短。乳酸浓度正常的患者死亡率为9%，高乳酸血症患者死亡率为23%。死亡率随乳酸浓度升高而增加，乳酸浓度为2 - 4 mEq/L的患者死亡率为17%，浓度超过8 mEq/L的患者死亡率为64%。非存活者入院时、24小时和48小时后的乳酸浓度均高于存活者。入院时存在的发生高乳酸血症的危险因素包括SOFA评分>5、平均动脉血压低于70 mmHg、血糖高于110 mg/dl以及当前使用血管升压药。