创伤患者初始血乳酸和碱缺失预后意义的比较

Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients.

作者信息

Raux Mathieu, Le Manach Yannick, Gauss Tobias, Baumgarten Romain, Hamada Sophie, Harrois Anatole, Riou Bruno, Duranteau Jacques, Langeron Olivier, Mantz Jean, Paugam-Burtz Catherine, Vigue Bernard

机构信息

From the Sorbonne Universités, UPMC Univ Paris 06, Pierre et Marie-Curie-Paris 6, UMRS 1166 (B.R.), and UMRS 1158, Neurophysiologie Respiratoire Experimentale et Clinique (M.R.), Paris, France; Departments of Anesthesiology and Critical Care (M.R., R.B.) and Emergency Medicine and Surgery (B.R.), Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Departments of Anesthesia and Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Y.L.M.); Department of Anesthesiology and Critical Care, CHU Beaujon, APHP, Clichy, France (T.G.); and Department of Anesthesiology and Critical Care, CHU Bicêtre, APHP, Le Kremlin-Bicêtre, France (S.H., A.H). Le Kremlin-Bicêtre, France Paris, France Paris, France Clichy, France Le Kremlin-Bicêtre, France.

出版信息

Anesthesiology. 2017 Mar;126(3):522-533. doi: 10.1097/ALN.0000000000001490.

DOI:10.1097/ALN.0000000000001490

PMID:28059838

Abstract

BACKGROUND

Initial blood lactate and base deficit have been shown to be prognostic biomarkers in trauma, but their respective performances have not been compared.

METHODS

Blood lactate levels and base deficit were measured at admission in trauma patients in three level 1 trauma centers. This was a retrospective analysis of prospectively acquired data. The association of initial blood lactate and base deficit with mortality was tested using receiver operating characteristics curve, logistic regression using triage scores (Revised Trauma Score and Mechanism Glasgow scale and Arterial Pressure score), and Trauma Related Injury Severity Score as a reference standard. The authors also used a reclassification method.

RESULTS

The authors evaluated 1,075 trauma patients (mean age, 39 ± 18 yr, with 90% blunt and 10% penetrating injuries and a mortality of 13%). At admission, blood lactate was elevated in 425 (39%) patients and base deficit was elevated in 725 (67%) patients. Blood lactate was correlated with base deficit (R = 0.54; P < 0.001). Using logistic regression, blood lactate was a better predictor of death than base deficit when considering its additional predictive value to triage scores and Trauma Related Injury Severity Score. This result was confirmed using a reclassification method but only in the subgroup of normotensive patients (n = 745).

CONCLUSIONS

Initial blood lactate should be preferred to base deficit as a biologic variable in scoring systems built to assess the initial severity of trauma patients.

摘要

背景

初始血乳酸和碱缺失已被证明是创伤的预后生物标志物，但它们各自的表现尚未得到比较。

方法

在三个一级创伤中心对创伤患者入院时测定血乳酸水平和碱缺失。这是对前瞻性收集数据的回顾性分析。使用受试者工作特征曲线、采用分诊评分（修订创伤评分、格拉斯哥机制评分和动脉压评分）的逻辑回归以及创伤相关损伤严重度评分作为参考标准，测试初始血乳酸和碱缺失与死亡率的相关性。作者还使用了重新分类方法。

结果

作者评估了1075例创伤患者（平均年龄39±18岁，90%为钝性伤，10%为穿透伤，死亡率为13%）。入院时，425例（39%）患者血乳酸升高，725例（67%）患者碱缺失升高。血乳酸与碱缺失相关（R = 0.54；P < 0.001）。使用逻辑回归，考虑到血乳酸对分诊评分和创伤相关损伤严重度评分的额外预测价值，其比碱缺失是更好的死亡预测指标。使用重新分类方法证实了这一结果，但仅在血压正常患者亚组（n = 745）中如此。