Department of Clinical Sciences, Intensive and Perioperative Care, Lund University, Skane University Hospital, Malmö, Sweden.
Department of Clinical Sciences, Cardiology, Lund University, Skane University Hospital, Lund, Sweden.
Acta Anaesthesiol Scand. 2018 Nov;62(10):1436-1442. doi: 10.1111/aas.13172. Epub 2018 Jun 21.
Admission lactate and lactate clearance are implemented for risk stratification in sepsis and trauma. In out-of-hospital cardiac arrest, results regarding outcome and lactate are conflicting.
This is a post-hoc analysis of the Target Temperature Management trial in which 950 unconscious patents after out-of-hospital cardiac arrest were randomized to a temperature intervention of 33°C or 36°C. Serial lactate samples during the first 36 hours were collected. Admission lactate, 12-hour lactate, and the clearance of lactate within 12 hours after admission were analyzed and the association with 30-day mortality assessed.
Samples from 877 patients were analyzed. In univariate logistic regression analysis, the odds ratio for death by day 30 for each mmol/L was 1.12 (1.08-1.16) for admission lactate, P < .01, 1.21 (1.12-1.31) for 12-hour lactate, P < .01, and 1.003 (1.00-1.01) for each percentage point increase in 12-hour lactate clearance, P = .03. Only admission lactate and 12-hour lactate levels remained significant after adjusting for known predictors of outcome. The area under the receiver operating characteristic curve was 0.65 (0.61-0.69), P < .001, 0.61 (0.57-0.65), P < .001, and 0.53 (0.49-0.57), P = .15 for admission lactate, 12-hour lactate, and 12-hour lactate clearance, respectively.
Admission lactate and 12-hour lactate values were independently associated with 30-day mortality after out-of-hospital cardiac arrest while 12-hour lactate clearance was not. The clinical value of lactate as the sole predictor of outcome after out-of-hospital cardiac arrest is, however, limited.
入院时的血乳酸值和乳酸清除率用于对脓毒症和创伤进行风险分层。在院外心脏骤停中，关于预后和乳酸的结果存在争议。
这是 Target Temperature Management 试验的事后分析，其中 950 名无意识的院外心脏骤停后患者被随机分配到 33°C 或 36°C 的体温干预组。在最初的 36 小时内采集连续的血乳酸样本。分析入院时的血乳酸值、12 小时的血乳酸值以及入院后 12 小时内的血乳酸清除率，并评估与 30 天死亡率的相关性。
对 877 名患者的样本进行了分析。在单变量逻辑回归分析中，入院时每增加 1mmol/L 的血乳酸，第 30 天死亡的优势比为 1.12（1.08-1.16），P<0.01，12 小时的血乳酸为 1.21（1.12-1.31），P<0.01，12 小时的血乳酸清除率每增加 1%，优势比为 1.003（1.00-1.01），P=0.03。在调整已知预后预测因素后，只有入院时的血乳酸值和 12 小时的血乳酸值仍然有意义。接受者操作特征曲线下的面积为 0.65（0.61-0.69），P<0.001，0.61（0.57-0.65），P<0.001，0.53（0.49-0.57），P=0.15，分别为入院时的血乳酸值、12 小时的血乳酸值和 12 小时的血乳酸清除率。
入院时的血乳酸值和 12 小时的血乳酸值与院外心脏骤停后 30 天的死亡率独立相关，而 12 小时的血乳酸清除率则没有。然而，血乳酸作为院外心脏骤停后唯一的预后预测因子的临床价值是有限的。
