Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca. Illes Balears, Spain.
J Crit Care. 2017 Dec;42:200-205. doi: 10.1016/j.jcrc.2017.07.039. Epub 2017 Jul 24.
To describe the incidence, causes and associated mortality of hyperlactatemia in critically ill patients and to evaluate the association between lactate clearance and in-hospital survival.
Retrospective cohort study of patients with hyperlactatemia admitted to the ICU. Hyperlactatemia was defined as a blood lactate concentration ≥5mmol/L and high-grade hyperlactatemia a lactate level ≥10mmol/L. Lactate clearance was calculated as the percentage of decrease in lactate concentration from the peak value.
Of 10,123 patients, 1373 (13.6%) had lactate concentration ≥5mmol/L, and 434(31.6%) of them had ≥10mmol/L. The most common causes of hyperlactatemia were sepsis/septic shock and post-cardiac surgery. An association was found between lactate concentration and in-hospital mortality (p<0.001). The area under the receiver-operating-characteristics (ROC) of lactate concentration and the optimal cut off to predict mortality were 0.72 (0.70-0.75) and 8.6mmol/L, respectively. ROC analysis for lactate clearance to predict in-hospital survival showed that the best area under the curve was obtained at 12h: 0.67 (95% confidence interval 0.59-0.75).
Hyperlactatemia was common and associated with a high mortality in critically ill patients. Lactate clearance had limited utility for predicting in-hospital survival.
描述危重症患者高乳酸血症的发生率、病因和相关死亡率，并评估乳酸清除率与院内生存率之间的关系。
对入住 ICU 的高乳酸血症患者进行回顾性队列研究。高乳酸血症定义为血乳酸浓度≥5mmol/L，重度高乳酸血症定义为乳酸水平≥10mmol/L。乳酸清除率计算为血乳酸浓度从峰值下降的百分比。
在 10123 名患者中，有 1373 名（13.6%）患者的血乳酸浓度≥5mmol/L，其中 434 名（31.6%）患者的血乳酸浓度≥10mmol/L。高乳酸血症最常见的病因是脓毒症/脓毒性休克和心脏手术后。乳酸浓度与院内死亡率之间存在关联（p<0.001）。乳酸浓度的受试者工作特征曲线（ROC）下面积和预测死亡率的最佳截断值分别为 0.72（0.70-0.75）和 8.6mmol/L。乳酸清除率预测院内生存率的 ROC 分析显示，12 小时时曲线下面积最佳：0.67（95%置信区间 0.59-0.75）。
危重症患者高乳酸血症很常见，且与高死亡率相关。乳酸清除率对预测院内生存率的作用有限。
