Vincent Jean-Louis, Quintairos E Silva Amanda, Couto Lúcio, Taccone Fabio S
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
Crit Care. 2016 Aug 13;20(1):257. doi: 10.1186/s13054-016-1403-5.
The time course of blood lactate levels could be helpful to assess a patient's response to therapy. Although the focus of published studies has been largely on septic patients, many other studies have reported serial blood lactate levels in different groups of acutely ill patients.
We performed a systematic search of PubMed, Science Direct, and Embase until the end of February 2016 plus reference lists of relevant publications. We selected all observational and interventional studies that evaluated the capacity of serial blood lactate concentrations to predict outcome. There was no restriction based on language. We excluded studies in pediatric populations, experimental studies, and studies that did not report changes in lactate values or all-cause mortality rates. We separated studies according to the type of patients included. We collected data on the number of patients, timing of lactate measurements, minimum lactate level needed for inclusion if present, and suggested time interval for predictive use.
A total of 96 studies met our criteria: 14 in general ICU populations, five in general surgical ICU populations, five in patients post cardiac surgery, 14 in trauma patients, 39 in patients with sepsis, four in patients with cardiogenic shock, eight in patients after cardiac arrest, three in patients with respiratory failure, and four in other conditions. A decrease in lactate levels over time was consistently associated with lower mortality rates in all subgroups of patients. Most studies reported changes over 6, 12 or 24 hrs, fewer used shorter time intervals. Lactate kinetics did not appear very different in patients with sepsis and other types of patients. A few studies suggested that therapy could be guided by these measurements.
The observation of a better outcome associated with decreasing blood lactate concentrations was consistent throughout the clinical studies, and was not limited to septic patients. In all groups, the changes are relatively slow, so that lactate measurements every 1-2 hrs are probably sufficient in most acute conditions. The value of lactate kinetics appears to be valid regardless of the initial value.
血乳酸水平的时间变化过程有助于评估患者对治疗的反应。尽管已发表研究主要关注脓毒症患者，但许多其他研究也报告了不同急性病患者群体的系列血乳酸水平。
我们对PubMed、Science Direct和Embase进行了系统检索，直至2016年2月底，并检索了相关出版物的参考文献列表。我们选择了所有评估系列血乳酸浓度预测结局能力的观察性和干预性研究。不设语言限制。我们排除了儿科人群研究、实验性研究以及未报告乳酸值变化或全因死亡率的研究。我们根据纳入患者的类型对研究进行分类。我们收集了患者数量、乳酸测量时间、若有纳入所需的最低乳酸水平以及预测使用的建议时间间隔等数据。
共有96项研究符合我们的标准：14项针对综合重症监护病房患者，5项针对普通外科重症监护病房患者，5项针对心脏手术后患者，14项针对创伤患者，39项针对脓毒症患者，4项针对心源性休克患者，8项针对心脏骤停后患者，3项针对呼吸衰竭患者，4项针对其他情况患者。所有患者亚组中，乳酸水平随时间下降均与较低死亡率一致相关。大多数研究报告的是6、12或24小时内的变化，较少使用更短的时间间隔。脓毒症患者和其他类型患者的乳酸动力学似乎没有太大差异。少数研究表明这些测量可指导治疗。
整个临床研究中，血乳酸浓度降低与更好结局相关的观察结果是一致的，且不限于脓毒症患者。在所有组中，变化相对缓慢，因此在大多数急性情况下，每1 - 2小时测量一次乳酸可能就足够了。无论初始值如何，乳酸动力学的价值似乎都是有效的。
