Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS.
Departments of Medicine, Division of Critical Care Medicine and Emergency Medicine, Cooper University Hospital, Camden, NJ.
Chest. 2013 Jun;143(6):1548-1553. doi: 10.1378/chest.12-0878.
We sought to compare the association of whole-blood lactate kinetics with survival in patients with septic shock undergoing early quantitative resuscitation.
This was a preplanned analysis of a multicenter, ED-based, randomized, controlled trial of early sepsis resuscitation. Inclusion criteria were suspected infection, two or more systemic inflammation criteria, either systolic BP< 90 mm Hg after a fluid bolus or lactate level > 4 mM, two serial lactate measurements, and an initial lactate level > 2.0 mM. We calculated the relative lactate clearance, rate of lactate clearance, and occurrence of early lactate normalization (decline to < 2.0 mM in the first 6 h). Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were used to determine the lactate kinetic parameters that were the strongest predictors of survival.
The analysis included 187 patients, of whom 36% (n = 68) normalized their lactate level. Overall survival was 76.5% (143 of 187 patients), and the AUC of initial lactate to predict survival was 0.64. The AUCs for relative lactate clearance and lactate clearance rate were 0.67 and 0.58, respectively. Lactate normalization was the strongest predictor of survival (adjusted OR, 5.2; 95% CI, 1.7-15.8), followed by lactate clearance ≥ 50% (OR, 4.0; 95% CI, 1.6-10.0). Lactate clearance ≥ 10% (OR, 1.6; 95% CI, 0.6-4.4) was not a significant independent predictor in this cohort.
In patients in the ED with a sepsis diagnosis, early lactate normalization during the first 6 h of resuscitation was the strongest independent predictor of survival and was superior to other measures of lactate kinetics.
ClinicalTrials.gov; No.: NCT00372502; URL: clinicaltrials.gov.
我们旨在比较全血乳酸动力学与接受早期定量复苏的脓毒性休克患者生存的相关性。
这是一项对早期脓毒症复苏的多中心、ED 为基础的、随机、对照试验的预先计划的分析。纳入标准为疑似感染、存在两种或更多全身炎症标准、液体冲击后收缩压＜90mmHg 或乳酸水平＞4mM、两次连续的乳酸测量以及初始乳酸水平＞2.0mM。我们计算了相对乳酸清除率、乳酸清除率和早期乳酸正常化（在最初的 6 小时内下降至＜2.0mM）的发生率。接收者操作特征曲线（ROC）下面积（AUC）和多变量逻辑回归用于确定乳酸动力学参数是生存的最强预测因子。
该分析包括 187 例患者，其中 36%（n=68）乳酸水平正常化。总生存率为 76.5%（187 例患者中的 143 例），初始乳酸预测生存率的 AUC 为 0.64。相对乳酸清除率和乳酸清除率的 AUC 分别为 0.67 和 0.58。乳酸正常化是生存的最强预测因子（调整后的 OR，5.2；95%CI，1.7-15.8），其次是乳酸清除率≥50%（OR，4.0；95%CI，1.6-10.0）。在该队列中，乳酸清除率≥10%（OR，1.6；95%CI，0.6-4.4）不是一个显著的独立预测因子。
在 ED 中诊断为脓毒症的患者中，在复苏的最初 6 小时内早期乳酸正常化是生存的最强独立预测因子，优于其他乳酸动力学测量。
ClinicalTrials.gov；编号：NCT00372502；网址：clinicaltrials.gov。
