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入院时外周静脉血乳酸水平与院内死亡率相关,一项前瞻性队列研究。

Peripheral venous lactate at admission is associated with in-hospital mortality, a prospective cohort study.

作者信息

Barfod C, Lundstrøm L H, Lauritzen M M P, Danker J K, Sölétormos G, Forberg J L, Berlac P A, Lippert F K, Antonsen K, Lange K H W

机构信息

Department of Anaesthesia and Intensive Care, Nordsjaellands Hospital - Hillerød, Hillerød, Denmark.

出版信息

Acta Anaesthesiol Scand. 2015 Apr;59(4):514-23. doi: 10.1111/aas.12503.

Abstract

BACKGROUND

The prognostic value of blood lactate as a predictor of adverse outcome in the acutely ill patient is unclear. The aim of this study was to investigate if a peripheral venous lactate measurement, taken at admission, is associated with in-hospital mortality in acutely ill patients with all diagnosis. Furthermore, we wanted to investigate if the test improves a triage model in terms of predicting in-hospital mortality.

METHODS

We retrieved a cohort of 2272 adult patients from a prospectively gathered acute admission database. We performed regression analysis to evaluate the association between the relevant covariates and the outcome measure: in-hospital mortality.

RESULTS

Lactate as a continuous variable was a risk for in-hospital mortality with an odds ratio (OR) of 1.40 [95% confidence interval (CI) 1.25-1.57, P<0.0001]. OR for in-hospital mortality increased with increasing lactate levels from 2.97 (95% CI 1.55-5.72, P<0.001) for lactate between 2 mmol/l and 4 mmol/l, to 7.77 (95% CI 3.23-18.66, P<0.0001) for lactate>4 mmol/l. If the condition was non-compensated (i.e. pH<7.35), OR for in-hospital mortality increased to 19.99 (7.26-55.06, P<0.0001). Patient with a blood lactate at 4 mmol/l or more had a risk of in-hospital mortality equivalent to the patients in the most urgent triage category.

CONCLUSION

We found elevated admission peripheral venous lactate to be independently associated with in-hospital mortality in the acutely ill patient admitted to the emergency department. Patients with a lactate>4 mmol/l at hospital admission should be considered triaged to the most urgent triage category.

摘要

背景

血乳酸作为急性病患者不良结局预测指标的预后价值尚不清楚。本研究的目的是调查入院时外周静脉血乳酸测量值是否与所有诊断的急性病患者的院内死亡率相关。此外,我们想研究该检测在预测院内死亡率方面是否能改进分诊模型。

方法

我们从一个前瞻性收集的急性入院数据库中检索了一组2272例成年患者。我们进行回归分析以评估相关协变量与结局指标(院内死亡率)之间的关联。

结果

乳酸作为连续变量是院内死亡的危险因素,比值比(OR)为1.40[95%置信区间(CI)1.25 - 1.57,P < 0.0001]。院内死亡率的OR随着乳酸水平升高而增加,乳酸在2 mmol/l至4 mmol/l之间时为2.97(95% CI 1.55 - 5.72,P < 0.001),乳酸>4 mmol/l时为7.77(95% CI 3.23 - 18.66,P < 0.0001)。如果病情未得到代偿(即pH < 7.35),院内死亡率的OR增加至19.99(7.26 - 55.06,P < 0.0001)。血乳酸水平在4 mmol/l及以上的患者的院内死亡风险与最紧急分诊类别的患者相当。

结论

我们发现急诊科收治的急性病患者入院时外周静脉血乳酸升高与院内死亡率独立相关。入院时乳酸>4 mmol/l的患者应被考虑分诊到最紧急的分诊类别。

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