Department of Emergency Medicine, State University of New York, Downstate Medical Center and Kings County Hospital, Brooklyn, NY, USA.
Research Division, Statistical Design & Analysis, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.
Am J Emerg Med. 2018 May;36(5):784-788. doi: 10.1016/j.ajem.2017.10.015. Epub 2017 Oct 7.
Emergency physicians face the challenge of rapidly identifying high-risk trauma patients. Lactate (LAC) is widely used as a surrogate of tissue hypoperfusion. However, clinically important values for LAC as a predictor of mortality are not well defined.
Retrospective chart review of trauma patients with a significant injury mechanism that warranted labs at an urban trauma center.
In-hospital mortality. Data are presented as median and quartiles or percentages with 95% confidence intervals. Groups (lived vs. died) were compared with Man-Whitney-U or Fisher's-exact test. Multivariate analysis was used to measure the association of the independent variables and mortality. The interval likelihood ratios were calculated for all LAC observed values.
10,575 patients; median age: 38 [25-57]; 69% male; 76% blunt; 1.1% [n=119] mortality. LAC was statistically different between groups in univariate (2.3 [1.6,3.0] vs 2.8 [1.6,4.8], p=0.008) and multivariate analyses (odds ratio: 1.14 [1.08-1.21], p=0.0001). Interval ratios for LR- ranged from 0.6-1.0. Increasing LAC increased LR+. However, LR+ for LAC reached 5 with LAC>9mmol/L and passed 10 (moderate and conclusive increase in disease probability, respectively) with LAC>18mmol/L.
In a cohort of trauma patients with a wide spectrum of characteristics triage LAC was statistically able to identify patients at high risk of mortality. However, clinically meaningful contribution to decision-making occurred only at LAC>9. LAC was not useful at excluding those with a low risk of mortality.
急诊医生面临着快速识别高危创伤患者的挑战。乳酸（LAC）被广泛用作组织低灌注的替代物。然而，LAC 作为死亡率预测指标的临床重要值尚未得到很好的定义。
回顾性分析了一家城市创伤中心因严重损伤机制而需要实验室检查的创伤患者的病历。
院内死亡率。数据以中位数和四分位数或百分比（95%置信区间）表示。用 Mann-Whitney-U 或 Fisher's-exact 检验比较组（存活与死亡）。多变量分析用于测量独立变量与死亡率的相关性。计算了所有观察到的 LAC 值的间隔似然比。
10575 例患者；中位年龄：38 [25-57]；69%为男性；76%为钝器伤；1.1%（n=119）死亡。在单变量和多变量分析中，LAC 在组间存在统计学差异（2.3 [1.6,3.0] vs 2.8 [1.6,4.8]，p=0.008）（优势比：1.14 [1.08-1.21]，p=0.0001）。LR-的间隔比范围为 0.6-1.0。随着 LAC 的增加，LR+增加。然而，当 LAC>9mmol/L 时，LR+达到 5，当 LAC>18mmol/L 时，LR+超过 10（分别为疾病概率的中度和明确增加）。
在一组具有广泛特征的创伤患者中，分诊 LAC 能够在统计学上识别出高死亡率风险的患者。然而，只有在 LAC>9 时，LR+对决策才有临床意义。LAC 对于排除低死亡率患者没有帮助。
