Kim Jung Chang, Lee Byung Kook, Lee Dong Hun, Jung Yong Hun, Cho Yong Soo, Lee Sung Min, Lee Seung Joon, Park Chi Ho, Jeung Kyung Woon
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.
Department of Emergency Medicine, Seonam University Myongji Hospital, Goyang, Korea.
Clin Exp Emerg Med. 2017 Mar 30;4(1):10-18. doi: 10.15441/ceem.16.149. eCollection 2017 Mar.
We investigated the association between lactate clearance or serum lactate levels and neurologic outcomes or in-hospital mortality in cardiac arrest survivors who were treated with targeted temperature management (TTM).
A retrospective analysis of data from cardiac arrest survivors treated with TTM between 2012 and 2015 was conducted. Serum lactate levels were measured on admission and at 12, 24, and 48 hours following admission. Lactate clearance at 12, 24, and 48 hours was also calculated. The primary outcome was neurologic outcome at discharge. The secondary outcome was in-hospital mortality.
The study included 282 patients; 184 (65.2%) were discharged with a poor neurologic outcome, and 62 (22.0%) died. Higher serum lactate levels at 12 hours (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.006 to 1.331), 24 hours (OR, 1.320; 95% CI, 1.084 to 1.607), and 48 hours (OR, 2.474; 95% CI, 1.459 to 4.195) after admission were associated with a poor neurologic outcome. Furthermore, a higher serum lactate level at 48 hours (OR, 1.459; 95% CI, 1.181 to 1.803) following admission was associated with in-hospital mortality. Lactate clearance was not associated with neurologic outcome or in-hospital mortality at any time point after adjusting for confounders.
Increased serum lactate levels after admission are associated with a poor neurologic outcome at discharge and in-hospital mortality in cardiac arrest survivors treated with TTM. Conversely, lactate clearance is not a robust surrogate marker of neurologic outcome or in-hospital mortality.
我们研究了接受目标温度管理（TTM）治疗的心脏骤停幸存者中乳酸清除率或血清乳酸水平与神经学预后或院内死亡率之间的关联。
对2012年至2015年间接受TTM治疗的心脏骤停幸存者的数据进行回顾性分析。入院时以及入院后12、24和48小时测量血清乳酸水平。还计算了12、24和48小时的乳酸清除率。主要结局是出院时的神经学预后。次要结局是院内死亡率。
该研究纳入了282例患者；184例（65.2%）出院时神经学预后不良，62例（22.0%）死亡。入院后12小时（比值比[OR]，1.157；95%置信区间[CI]，1.006至1.331）、24小时（OR，1.320；95%CI，1.084至1.607）和48小时（OR，2.474；95%CI，1.459至4.195）时较高的血清乳酸水平与不良神经学预后相关。此外，入院后48小时（OR，1.459；95%CI，1.181至1.803）较高的血清乳酸水平与院内死亡率相关。在调整混杂因素后，乳酸清除率在任何时间点均与神经学预后或院内死亡率无关。
入院后血清乳酸水平升高与接受TTM治疗的心脏骤停幸存者出院时不良神经学预后及院内死亡率相关。相反，乳酸清除率并非神经学预后或院内死亡率的可靠替代指标。
