Dell'Anna Antonio Maria, Sandroni Claudio, Lamanna Irene, Belloni Ilaria, Donadello Katia, Creteur Jacques, Vincent Jean-Louis, Taccone Fabio Silvio
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
Department of Anesthesiology and Intensive Care, Catholic University School of Medicine, Largo Agostino Gemelli 8, 00168, Rome, Italy.
Ann Intensive Care. 2017 Oct 6;7(1):101. doi: 10.1186/s13613-017-0321-2.
Elevated lactate concentration has been associated with increased mortality after out-of-hospital cardiac arrest (CA). We investigated the variables associated with high blood lactate concentrations and explored the relationship between blood lactate and neurological outcome in this setting.
This was a retrospective analysis of an institutional database that included all adult (> 18 years) patients admitted to a multidisciplinary Department of Intensive Care between January 2009 and January 2013 after resuscitation from CA. Blood lactate concentrations were collected at hospital admission and 6, 12, 24 and 48 h thereafter. Neurological outcome was evaluated 3 months post-CA using the Cerebral Performance Category (CPC) score: a CPC of 3-5 was used to define a poor outcome.
Of the 236 patients included, 162 (69%) had a poor outcome. On admission, median lactate concentrations (5.3[2.9-9.0] vs. 2.5[1.5-5.5], p < 0.001) and cardiovascular sequential organ failure assessment (cSOFA) score (3[0-4] vs. 0[0-3], p = 0.003) were higher in patients with poor than in those with favourable outcomes. Lactate concentrations were higher in patients with poor outcomes at all time points. Lactate concentrations were similar in patients with out-of-hospital and in-hospital CA at all time points. After adjustment, high admission lactate was independently associated with a poor neurological outcome (OR 1.18, 95% CI 1.08-1.30; p < 0.001). In multivariable analysis, use of vasopressors and high PaO on admission, longer time to return of spontaneous circulation and altered renal function were associated with high admission lactate concentrations.
High lactate concentrations on admission were an independent predictor of poor neurological recovery post-CA, but the time course was not related to outcome. Prolonged resuscitation, use of vasopressors, high PaO and altered renal function were predictors of high lactate concentrations.
院外心脏骤停（CA）后乳酸浓度升高与死亡率增加相关。我们调查了与高血乳酸浓度相关的变量，并探讨了在此情况下血乳酸与神经功能结局之间的关系。
这是一项对机构数据库的回顾性分析，纳入了2009年1月至2013年1月间在多学科重症监护科接受治疗的所有成年（>18岁）CA复苏后患者。入院时及此后6、12、24和48小时采集血乳酸浓度。CA后3个月使用脑功能分类（CPC）评分评估神经功能结局：CPC评分为3 - 5定义为不良结局。
纳入的236例患者中，162例（69%）结局不良。入院时，结局不良患者的乳酸浓度中位数（5.3[2.9 - 9.0] vs. 2.5[1.5 - 5.5]，p<0.001）和心血管序贯器官衰竭评估（cSOFA）评分（3[0 - 4] vs. 0[0 - 3]，p = 0.003）高于结局良好患者。所有时间点结局不良患者的乳酸浓度均较高。院外CA和院内CA患者在所有时间点的乳酸浓度相似。调整后，入院时高乳酸与不良神经功能结局独立相关（比值比1.18，95%可信区间1.08 - 1.30；p<0.001）。多变量分析中，入院时使用血管升压药、高动脉血氧分压、自主循环恢复时间延长和肾功能改变与入院时高乳酸浓度相关。
入院时高乳酸浓度是CA后神经功能恢复不良的独立预测因素，但时间进程与结局无关。长时间复苏、使用血管升压药、高动脉血氧分压和肾功能改变是高乳酸浓度的预测因素。
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