高血清乳酸水平可能预测24小时内死亡。
High serum lactate level may predict death within 24 hours.
作者信息
Blum Arnon, Zoubi Abd Almajid, Kuria Shiran, Blum Nava
机构信息
Department of Medicine, Baruch Padeh Poriya Hospital, Bar Ilan University, Lower Galilee 15208, Israel, Tel: +972-4-665-2688.
Department of Medicine, Baruch Padeh Poria Hospital, Faculty of Medicine Bar Ilan University, Israel.
出版信息
Open Med (Wars). 2015 Jun 11;10(1):318-322. doi: 10.1515/med-2015-0045. eCollection 2015.
BACKGROUND
Unexpected death within 24 hours of admission is a real challenge for the clinician in the emergency room. How to diagnose these patients and the right approach to prevent sudden death with 24 hours is still an enigma. The aims of our study were to find the independent factors that may affect the clinical outcome in the first 24 hours of admission to the hospital.
METHODS
We performed a retrospective study defining unexpected death within 24 hours of admission in our Department of Medicine in the last 6 years. We found 43 patients who died within 24 hours of admission, and compared their clinical and biochemical characteristics to 6055 consecutive patients who were admitted in that period of time and did not die within the first 24 hours of admission. The parameters that were used include gender, age, temperature, clinical and laboratory criteria for SIRS, arterial blood lactate, and arterial blood pH.
RESULTS
Most of the patients who died within 24 hours had sepsis with SIRS. These patients were older (78.6±14.7 vs. 65.2±20.2 years [p<.0001]), had higher lactate levels (8.0±4.8 vs. 2.1±1.8mmol/L [p<.0001]), and lower pH (7.2±0.2 vs. 7.4±0.1 [p<.0001]). Logistic regression analysis found that lactate was the strongest independent parameter to predict death within 24 hours of admission (OR 1.366 [95% CI 1.235-1.512]), followed by old age (OR 1.048 [95% CI 1.048-1.075] and low arterial blood pH (OR 0.007 [CI <0.001-0.147]). When gender was analyzed, pH was not an independent variable in females (only in males).
CONCLUSIONS
The significant independent variable that predicted death within 24 hours of admission was arterial blood lactate level on admission. Older age was also an independent variable; low pH affected only males, but was a less dominant variable. We suggest use of arterial blood lactate level on admission as a bio-marker in patients with suspected sepsis admitted to the hospital for risk assessment and prediction of death within 24 hours of admission.
背景
入院后24小时内意外死亡对急诊室的临床医生来说是一项严峻挑战。如何诊断这些患者以及在24小时内预防猝死的正确方法仍是一个谜。我们研究的目的是找出可能影响入院后最初24小时临床结局的独立因素。
方法
我们进行了一项回顾性研究，定义了过去6年我院内科入院后24小时内的意外死亡情况。我们找出了43例入院后24小时内死亡的患者，并将他们的临床和生化特征与同期入院且在入院后最初24小时内未死亡的6055例连续患者进行比较。所使用的参数包括性别、年龄、体温、全身炎症反应综合征（SIRS）的临床和实验室标准、动脉血乳酸和动脉血pH值。
结果
24小时内死亡的大多数患者患有伴有SIRS的脓毒症。这些患者年龄较大（78.6±14.7岁 vs. 65.2±20.2岁 [p<0.0001]），乳酸水平较高（8.0±4.8 vs. 2.1±1.8mmol/L [p<0.0001]），pH值较低（7.2±0.2 vs. 7.4±0.1 [p<0.0001]）。逻辑回归分析发现，乳酸是预测入院后24小时内死亡的最强独立参数（比值比1.366 [95%置信区间1.235 - 1.512]），其次是老年（比值比1.048 [95%置信区间1.048 - 1.075]）和动脉血pH值低（比值比0.007 [置信区间<0.001 - 0.147]）。分析性别时，pH值在女性中不是独立变量（仅在男性中是）。
结论
预测入院后24小时内死亡的显著独立变量是入院时的动脉血乳酸水平。老年也是一个独立变量；低pH值仅影响男性，但不是主要变量。我们建议将入院时的动脉血乳酸水平用作入院疑似脓毒症患者的生物标志物，用于风险评估和预测入院后24小时内的死亡情况。
Zotero 插件