早期乳酸清除与心脏骤停后综合征患者预后改善相关：一项前瞻性、多中心观察性研究（SOS-KANTO 2012研究）。

Early Lactate Clearance Is Associated With Improved Outcomes in Patients With Postcardiac Arrest Syndrome: A Prospective, Multicenter Observational Study (SOS-KANTO 2012 Study).

作者信息

Hayashida Kei, Suzuki Masaru, Yonemoto Naohiro, Hori Shingo, Tamura Tomoyoshi, Sakurai Atsushi, Tahara Yoshio, Nagao Ken, Yaguchi Arino, Morimura Naoto

机构信息

1Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan.2Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA.3Department of Biostatistics, School of Public Health, Kyoto University, Yoshida-konoe, Kyoto, Japan.4Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.5Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Osaka, Japan.6Cardiovascular Center, Nihon University Surugadai Hospital, Chiyoda-ku, Tokyo, Japan.7Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.8Department of Emergency Medicine, Yokohama City University Medical Center, Yokohama-City, Kanagawa, Japan.

出版信息

Crit Care Med. 2017 Jun;45(6):e559-e566. doi: 10.1097/CCM.0000000000002307.

DOI:10.1097/CCM.0000000000002307

PMID:28328649

Abstract

OBJECTIVES

To determine whether early lactate reduction is associated with improved survival and good neurologic outcome in patients with out-of-hospital cardiac arrest.

DESIGN

Ad hoc data analysis of a prospective, multicenter observational study.

SETTING

Out-of-hospital cardiac arrest patients at 67 emergency hospitals in Kanto, Japan between January 2012 and March 2013.

PATIENTS

Adult patients with out-of-hospital cardiac arrest admitted to the hospital after successful resuscitation were identified.

INTERVENTIONS

Blood lactate concentrations were measured at hospital admission and 6 h after hospital admission. Early lactate clearance was defined as the percent change in lactate level 6 h after a baseline measurement.

MEASUREMENTS AND MAIN RESULTS

The 543 patients (mean age, 65 ± 16 yr; 72.6% male) had a mean lactate clearance of 42.4% ± 53.7%. Overall 30-day survival and good neurologic outcome were 47.1% and 27.4%, respectively. The survival proportion increased with increasing lactate clearance (quartile 1, 29.4%; quartile 2, 42.6%; quartile 3, 51.5%; quartile 4, 65.2%; p < 0.001). Multivariate logistic regression analysis showed that lactate clearance quartile was an independent predictor of the 30-day survival and good neurologic outcome. In the Cox proportional hazards model, the frequency of mortality during 30 days was significantly higher for patients with lactate clearance in quartile 1 (hazard ratio, 3.12; 95% CI, 2.14-4.53), quartile 2 (hazard ratio, 2.13; 95% CI, 1.46-3.11), and quartile 3 (hazard ratio, 1.49; 95% CI, 1.01-2.19) than those with lactate clearance in quartile 4. Furthermore, multivariate logistic regression analysis revealed that lactate clearance was a significant predictor of good neurologic outcome at 30 days after hospital admission.

CONCLUSIONS

Effective lactate reduction over the first 6 hours of postcardiac arrest care was associated with survival and good neurologic outcome independently of the initial lactate level.

摘要

目的

确定院外心脏骤停患者早期血乳酸水平降低是否与生存率提高及良好的神经功能预后相关。

设计

对一项前瞻性多中心观察性研究进行的专项数据分析。

地点

2012年1月至2013年3月期间，日本关东地区67家急救医院的院外心脏骤停患者。

患者

成功复苏后入院的院外心脏骤停成年患者。

干预措施

在入院时及入院后6小时测量血乳酸浓度。早期乳酸清除率定义为基线测量后6小时乳酸水平的变化百分比。

测量指标及主要结果

543例患者（平均年龄65±16岁；72.6%为男性）的平均乳酸清除率为42.4%±53.7%。总体30天生存率和良好神经功能预后分别为47.1%和27.4%。生存率随乳酸清除率的增加而升高（四分位数1为29.4%；四分位数2为42.6%；四分位数3为51.5%；四分位数4为65.2%；p<0.001）。多因素logistic回归分析显示，乳酸清除率四分位数是30天生存率和良好神经功能预后的独立预测因素。在Cox比例风险模型中，乳酸清除率处于四分位数1（风险比，3.1；95%CI，2.14 - 4.53）、四分位数2（风险比，2.13；95%CI，1.46 - 3.11）和四分位数3（风险比，1.49；95%CI，1.01 - 2.19）的患者在30天内的死亡频率显著高于乳酸清除率处于四分位数4的患者。此外，多因素logistic回归分析显示，乳酸清除率是入院后30天良好神经功能预后的重要预测因素。