University of British Columbia, Critical Care Research Laboratories, Institute for Heart+Lung Health, St Paul's Hospital, Vancouver, British Columbia, Canada.
Shock. 2012 Jul;38(1):4-10. doi: 10.1097/SHK.0b013e318254d41a.
We hypothesized that lactate levels even within the normal range are prognostic and that low lactate levels predict a beneficial response to vasopressin infusion in septic shock. We conducted a retrospective analysis using the Vasopressin in Septic Shock Trial (VASST) as a derivation cohort (n = 665), then validated using another single-center septic shock cohort, St Paul's Hospital (SPH) cohort (n = 469). Lactate levels were divided into quartiles. The primary outcome variable was 28-day mortality in both cohorts. We used receiver operating characteristic (ROC) curve analysis to compare the prognostic value of lactate concentrations versus Acute Physiology and Chronic Health Evaluation II scores. We then explored whether lactate concentrations might predict beneficial response to vasopressin compared with noradrenaline in VASST. Normal lactate range is less than 2.3 mmol/L. At enrollment, patients in the second quartile (1.4 < lactate < 2.3 mmol/L) had significantly increased mortality and organ dysfunction compared with patients who had lactate ≤ 1.4 mmol/L (quartile 1) (P < 0.0001). Quartile 2 outcomes were as severe as quartile 3 (2.3 ≤ lactate < 4.4 mmol/L) outcomes. Baseline lactate values (ar ea under the ROC curve = 0.63, 0.66; VASST, SPH) were as good as Acute Physiology and Chronic Health Evaluation II scores (area under the ROC curve = 0.66, 0.73; VASST, SPH) as prognostic indicators of 28-day mortality. Lactate concentrations of 1.4 mmol/L or less predicted a beneficial response in those randomized to vasopressin compared with noradrenaline in VASST (P < 0.05). Lactate concentrations within the "normal" range can be a useful prognostic indicator in septic shock. Furthermore, patients whose lactate level is less than or equal to 1.4 mmol/L may benefit from vasopressin infusion.
我们假设乳酸水平即使在正常范围内也是预后指标，并且低乳酸水平预示着脓毒性休克患者对血管加压素输注有良好的反应。我们使用血管加压素在脓毒性休克试验（VASST）作为推导队列（n=665）进行回顾性分析，然后使用另一个单中心脓毒性休克队列圣保罗医院（SPH）队列（n=469）进行验证。乳酸水平分为四分位。主要结局变量是两个队列的 28 天死亡率。我们使用接收者操作特征（ROC）曲线分析比较乳酸浓度与急性生理学和慢性健康评估 II 评分的预后价值。然后，我们探讨了乳酸浓度是否可以预测 VASST 中与去甲肾上腺素相比血管加压素的有益反应。正常乳酸范围小于 2.3mmol/L。在入组时，第二四分位数（1.4<乳酸<2.3mmol/L）的患者与乳酸≤1.4mmol/L（第一四分位）的患者相比，死亡率和器官功能障碍显著增加（P<0.0001）。四分位 2 的结果与四分位 3（2.3≤乳酸<4.4mmol/L）的结果一样严重。基线乳酸值（ROC 曲线下面积=0.63，0.66；VASST，SPH）与急性生理学和慢性健康评估 II 评分（ROC 曲线下面积=0.66，0.73；VASST，SPH）一样，是 28 天死亡率的良好预后指标。VASST 中随机接受血管加压素与去甲肾上腺素相比，乳酸浓度为 1.4mmol/L 或更低的患者预测有良好的反应（P<0.05）。脓毒性休克患者的乳酸浓度在“正常”范围内可能是一个有用的预后指标。此外，乳酸水平≤1.4mmol/L 的患者可能受益于血管加压素输注。
