Klinik für Anaesthesiologie, Technische Universität München, Klinikum rechts der Isar, München, Germany.
Clin Chem Lab Med. 2013 Feb;51(2):405-12. doi: 10.1515/cclm-2012-0258.
The aim of the study was to retrospectively investigate whether parameters of routine point-of-care testing (POCT) predict hospital mortality in critically ill surgical patients on admission to the intensive care unit (ICU).
Arterial blood analyses of 1551 patients on admission to the adult surgical ICU of the Technical University Munich were reviewed. POCT was performed on a blood gas analyser. The association between acid-base status and mortality was evaluated. Metabolic acidosis was defined by base excess (BE) <-2 mmol/L and, wherever applicable, subdivided into lactic acidosis by lactate >50% of BE, anion gap (AG)-acidosis by AG >16 mmol/L, hyperchloraemic acidosis by chloride >115 mmol/L. Metabolic alkalosis was defined by BE ≥3 mmol/L. Logistic regression analysis identified variables independently associated with mortality.
Overall mortality was 8.8%. Mortality was greater in male patients (p=0.012). Mean age was greater in non-survivors (p<0.0005). Nine hundred and eighty-six patients showed no metabolic acid-base disorder (mortality 7.3%), thereof 26 patients with pCO(2)>55 mm Hg (mortality 23.1%). Three hundred and seventy-seven patients presented with acidosis (mortality 11.4%), thereof 163 patients with lactic acidosis (mortality 19%). Mortality for alkalosis (174 patients) was 12.1%. Mean blood glucose level for non-survivors was higher compared to survivors (p<0.0005). Logistic regression analysis identified lactate, glucose, age, male gender as independent predictors of mortality.
Lactate and glucose on ICU admission independently predict mortality. BE and AG failed as prognostic markers. Lactic acidosis showed a high mortality rate implying that lactate levels should be obtained on ICU admission. Prevalence of hyperchloraemic acidosis was low. Metabolic alkalosis was associated with an increased mortality. Further studies on this disturbance and its attendant high mortality are warranted.
本研究旨在回顾性分析危重症外科患者入住重症监护病房（ICU）时即时检验（POCT）的常规参数是否可预测其住院死亡率。
对慕尼黑工业大学成人外科 ICU 1551 例患者的动脉血气分析结果进行回顾性分析。POCT 在血气分析仪上进行。评估酸碱状态与死亡率之间的关系。代谢性酸中毒的定义为碱剩余（BE）<-2mmol/L，在适用的情况下，根据 BE 中乳酸含量超过 50%将其进一步分为乳酸酸中毒，阴离子间隙（AG）-酸中毒的 AG>16mmol/L，高氯性酸中毒的氯>115mmol/L。代谢性碱中毒的定义为 BE≥3mmol/L。采用逻辑回归分析确定与死亡率独立相关的变量。
总体死亡率为 8.8%。男性患者死亡率较高（p=0.012）。非幸存者的平均年龄较大（p<0.0005）。986 例患者无代谢性酸碱紊乱（死亡率 7.3%），其中 pCO（2）>55mmHg 的患者有 26 例（死亡率 23.1%）。377 例患者存在酸中毒（死亡率 11.4%），其中乳酸酸中毒患者 163 例（死亡率 19%）。碱中毒（174 例）死亡率为 12.1%。非幸存者的平均血糖水平高于幸存者（p<0.0005）。逻辑回归分析确定乳酸、血糖、年龄、男性为死亡率的独立预测因素。
入住 ICU 时的乳酸和血糖独立预测死亡率。BE 和 AG 不能作为预后标志物。乳酸酸中毒死亡率较高，提示应在入住 ICU 时检测乳酸水平。高氯性酸中毒的患病率较低。代谢性碱中毒与死亡率增加相关。需要进一步研究这种紊乱及其相关的高死亡率。
