Kawase Tomoharu, Toyofuku Mamoru, Higashihara Tasuku, Okubo Yousaku, Takahashi Lisa, Kagawa Yuzo, Yamane Kenichi, Mito Shinji, Tamekiyo Hiromichi, Otsuka Masaya, Okimoto Tomokazu, Muraoka Yuji, Masaoka Yoshiko, Shiode Nobuo, Hayashi Yasuhiko
Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
Division of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
J Cardiol. 2015 Feb;65(2):164-70. doi: 10.1016/j.jjcc.2014.05.006. Epub 2014 Jun 23.
The significance of routine measurement of lactate level is unclear in patients with critical acute decompensated heart failure (ADHF).
Consecutive 754 patients who were admitted to the intensive care unit (ICU) in our hospital from January 2007 to March 2012 and given a diagnosis of ADHF were eligible for retrospective entry into the registry. Lactate level was measured on admission from routine arterial blood sample and we investigated by comparing the lactate level and parameters of conventional in-hospital mortality predictors. Among the patients, 88 (12%) died during hospitalization. The lactate level had great power to predict in-hospital mortality, as suggested by the c-statistics of 0.71. The occurrence of in-hospital death was more pronounced in patients with high levels of lactate (>3.2mmol/l) and the tendency was observed in patients in both the acute coronary syndrome (ACS) group and non-ACS group. In multivariate analysis, elevated lactate levels remained an independent predictor of in-hospital death (odds ratio, 2.14; 95% confidence interval, 1.10-4.21; p=0.03).
Elevated levels of arterial lactate on admission were related to worse in-hospital mortality in patients with ADHF either with or without ACS, suggesting that the presence of high lactate in patients who enter the ICU with ADHF could help stratify the initial risk of early mortality.
在急性失代偿性心力衰竭（ADHF）危重症患者中，常规检测乳酸水平的意义尚不清楚。
对2007年1月至2012年3月我院重症监护病房（ICU）收治的连续754例诊断为ADHF的患者进行回顾性登记。入院时从常规动脉血样本中检测乳酸水平，并通过比较乳酸水平与传统院内死亡预测指标进行研究。患者中，88例（12%）住院期间死亡。乳酸水平对预测院内死亡率具有强大作用，c统计量为0.71表明了这一点。乳酸水平高（>3.2mmol/L）的患者院内死亡发生率更高，急性冠状动脉综合征（ACS）组和非ACS组患者均有此趋势。多因素分析中，乳酸水平升高仍是院内死亡的独立预测因素（比值比，2.14；95%置信区间，1.10 - 4.21；p = 0.03）。
入院时动脉血乳酸水平升高与ADHF患者（无论有无ACS）院内死亡率升高相关，这表明因ADHF入住ICU的患者中高乳酸的存在有助于对早期死亡的初始风险进行分层。
