Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, PO Box 30001, Groningen 9700 RB, the Netherlands.
Ann Intensive Care. 2013 Feb 27;3(1):6. doi: 10.1186/2110-5820-3-6.
Both hyperlactatemia and persistence of hyperlactatemia have been associated with bad outcome. We compared lactate and lactate-derived variables in outcome prediction.
Retrospective observational study. Case records from 2,251 consecutive intensive care unit (ICU) patients admitted between 2001 and 2007 were analyzed. Baseline characteristics, all lactate measurements, and in-hospital mortality were recorded. The time integral of arterial blood lactate levels above the upper normal threshold of 2.2 mmol/L (lactate-time-integral), maximum lactate (max-lactate), and time-to-first-normalization were calculated. Survivors and nonsurvivors were compared and receiver operating characteristic (ROC) analysis were applied.
A total of 20,755 lactate measurements were analyzed. Data are srpehown as median [interquartile range]. In nonsurvivors (n = 405) lactate-time-integral (192 [0-1881] min·mmol/L) and time-to-first normalization (44.0 [0-427] min) were higher than in hospital survivors (n = 1846; 0 [0-134] min·mmol/L and 0 [0-75] min, respectively; all p < 0.001). Normalization of lactate <6 hours after ICU admission revealed better survival compared with normalization of lactate >6 hours (mortality 16.6% vs. 24.4%; p < 0.001). AUC of ROC curves to predict in-hospital mortality was the largest for max-lactate, whereas it was not different among all other lactate derived variables (all p > 0.05). The area under the ROC curves for admission lactate and lactate-time-integral was not different (p = 0.36).
Hyperlactatemia is associated with in-hospital mortality in a heterogeneous ICU population. In our patients, lactate peak values predicted in-hospital mortality equally well as lactate-time-integral of arterial blood lactate levels above the upper normal threshold.
高乳酸血症和乳酸血症持续存在均与不良预后相关。我们比较了乳酸和乳酸衍生变量在预后预测中的作用。
回顾性观察性研究。分析了 2001 年至 2007 年间连续入住重症监护病房（ICU）的 2251 例患者的病例记录。记录了基线特征、所有乳酸测量值和院内死亡率。计算动脉血乳酸水平超过上限正常阈值 2.2mmol/L（乳酸时间积分）的时间积分（lactate-time-integral）、最大乳酸（max-lactate）和首次正常化时间。比较幸存者和非幸存者，并应用接受者操作特征（ROC）分析。
共分析了 20755 次乳酸测量值。数据以中位数[四分位数范围]表示。在非幸存者（n=405）中，乳酸时间积分（192[0-1881]min·mmol/L）和首次正常化时间（44.0[0-427]min）均高于院内幸存者（n=1846；0[0-134]min·mmol/L 和 0[0-75]min，均p<0.001）。ICU 入院后 6 小时内乳酸正常化与 6 小时后乳酸正常化相比，生存率更好（死亡率 16.6%vs.24.4%；p<0.001）。预测院内死亡率的 ROC 曲线的 AUC 最大的是最大乳酸，而其他所有乳酸衍生变量之间的 AUC 没有差异（p>0.05）。入院时乳酸和乳酸时间积分的 ROC 曲线下面积没有差异（p=0.36）。
高乳酸血症与 ICU 患者的院内死亡率相关。在我们的患者中，乳酸峰值与动脉血乳酸水平超过上限正常阈值的乳酸时间积分同样能预测院内死亡率。
