a Department of Intensive Care Medicine , Maastricht University Medical Centre , Maastricht , The Netherlands.
b Department of Cardiology , Maastricht University Medical Centre , Maastricht , The Netherlands.
Infect Dis (Lond). 2018 Mar;50(3):207-213. doi: 10.1080/23744235.2017.1383630. Epub 2017 Sep 26.
Clear definitions for septic shock assist clinicians regarding recognition, treatment and standardized reporting of characteristics and outcome of this entity. Sepsis-3 definition of septic shock incorporates a new criterion, a lactate level >2 mmol/L. Differences in epidemiology and outcome of septic shock based upon both definitions were studied in an intensive care (ICU) population of septic patients.
We analyzed a prospectively collected cohort of data in the ICU of the Maastricht University Medical Centre. 632 septic patients were included. ICU mortality was compared between the patient group fulfilling Sepsis-3 definition for septic shock and those that met Sepsis-2 definition. Furthermore, association between lactate levels and ICU mortality was studied.
Of 632 septic patients, 482 (76.3%) had septic shock according to Sepsis-2 and 300 patients (48.4%) according to Sepsis-3 definition, respectively. Patients meeting Sepsis-3 definition had a higher mortality than patients meeting Sepsis-2 definition (38.9 vs. 34.0%). Serum lactate levels between 2 and 4 mmol/L (25.0 vs. 26.2%, OR 0.94 (0.5-1.5)) and between 4 and 6 mmol/L (23.8 vs. 26.2%, OR 0.88 (0.4-1.7)) compared to levels ≤2 mmol/L were not associated with significantly higher ICU mortality. Serum lactate values ≥6 mmol/L, were significantly associated with increased ICU mortality.
Patients classified according to Sepsis-3 criteria had a higher ICU mortality compared with Sepsis-2 criteria. Lactate levels <6 mmol/L were not able to identify patients with increased ICU mortality. Lactate threshold of 2 mmol/L may be too low to point out patients with actual increased ICU mortality.
明确的脓毒症休克定义有助于临床医生识别、治疗和标准化报告该实体的特征和结果。脓毒症-3 对脓毒症休克的定义纳入了一个新的标准，即血乳酸水平＞2mmol/L。本研究旨在脓毒症患者的重症监护病房（ICU）人群中，比较基于这两种定义的脓毒症休克的流行病学和结局差异。
我们分析了马斯特里赫特大学医学中心 ICU 前瞻性收集的数据队列。共纳入 632 例脓毒症患者。比较符合脓毒症-3 定义的脓毒症休克患者和符合脓毒症-2 定义的患者的 ICU 死亡率。此外，还研究了血乳酸水平与 ICU 死亡率之间的关系。
632 例脓毒症患者中，根据脓毒症-2 标准，482 例（76.3%）为脓毒症休克，根据脓毒症-3 标准，300 例（48.4%）为脓毒症休克。符合脓毒症-3 定义的患者死亡率高于符合脓毒症-2 定义的患者（38.9%比 34.0%）。血乳酸水平在 2 至 4mmol/L 之间（25.0%比 26.2%，OR 0.94（0.5-1.5））和在 4 至 6mmol/L 之间（23.8%比 26.2%，OR 0.88（0.4-1.7））与≤2mmol/L 相比，与 ICU 死亡率无显著相关性。血乳酸值≥6mmol/L 与 ICU 死亡率增加显著相关。
与脓毒症-2 标准相比，根据脓毒症-3 标准分类的患者 ICU 死亡率更高。血乳酸水平＜6mmol/L 不能识别 ICU 死亡率增加的患者。2mmol/L 的乳酸阈值可能太低，无法指出 ICU 死亡率实际增加的患者。
