Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Republic of Korea,
Intensive Care Med. 2013 Oct;39(10):1818-23. doi: 10.1007/s00134-013-2959-z. Epub 2013 Jul 2.
We attempted to evaluate whether the early lactate area is useful as an early prognostic marker of mortality in pediatric septic shock patients.
We performed a retrospective study of pediatric patients with septic shock who were admitted to the pediatric intensive care unit of Asan Medical Center, Seoul, Korea. Serial arterial lactate levels were obtained immediately and then every 6 h after admission for a total of 24 h. The lactate area (mmol/lh) was defined as the sum of the area under the curve (AUC) of serial lactate levels measured during the 24 h following admission. We compared the lactate-associated parameters as a predictor of mortality.
A total of 65 patients were included in this study, and the overall 28-day mortality of these patients was 26.2%. Survivors compared with non-survivors had an initial lactate level of 3.13 ± 2.79 vs. 6.16 ± 4.87 mmol/l, a lactate clearance of 32.8 ± 63.4 vs. -30.8 ± 75.6%, and a lactate area of 59.7 ± 56.0 vs. 168.0 ± 107.0 mmol/lh (p < 0.05 for all variables). Receiver operating characteristic curves indicated a strong predictive power for the lactate area (AUC = 0.828), which demonstrated the largest AUC in comparison with the AUCs of the initial lactate level (0.699) or the 24-h lactate clearance (0.719). Using multivariate logistic regression analysis, the lactate area was a significant prognostic factor.
The early lactate area is a potentially feasible and clinically useful predictor of mortality in pediatric septic shock patients.
我们试图评估早期乳酸面积是否可作为儿科感染性休克患者死亡的早期预后标志物。
我们对韩国首尔 Asan 医疗中心儿科重症监护病房收治的感染性休克患儿进行了回顾性研究。在入院后立即和随后的每 6 小时连续测量动脉乳酸水平，共 24 小时。乳酸面积（mmol/lh）定义为入院后 24 小时内连续乳酸水平曲线下面积（AUC）的总和。我们比较了乳酸相关参数作为死亡率预测指标的情况。
本研究共纳入 65 例患儿，这些患儿的 28 天总体死亡率为 26.2%。与存活者相比，非存活者的初始乳酸水平为 3.13 ± 2.79 vs. 6.16 ± 4.87 mmol/l，乳酸清除率为 32.8 ± 63.4 vs. -30.8 ± 75.6%，乳酸面积为 59.7 ± 56.0 vs. 168.0 ± 107.0 mmol/lh（所有变量 p<0.05）。受试者工作特征曲线表明乳酸面积具有很强的预测能力（AUC=0.828），与初始乳酸水平（AUC=0.699）或 24 小时乳酸清除率（AUC=0.719）相比，其 AUC 最大。多变量逻辑回归分析显示，乳酸面积是一个重要的预后因素。
早期乳酸面积可能是儿科感染性休克患者死亡的一个可行且具有临床意义的预测指标。
