Hasegawa Daisuke, Nishida Kazuki, Hara Yoshitaka, Kawaji Takahiro, Moriyama Kazuhiro, Shimomura Yasuyo, Niimi Daisuke, Komura Hidefumi, Nishida Osamu
1Department of Anesthesiology and Critical Care Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192 Japan.
2Department of Biostatistics, Graduate School of Medicine, Nagoya University, Nagoya, Aichi Japan.
J Intensive Care. 2019 Jun 24;7:2. doi: 10.1186/s40560-019-0389-x. eCollection 2019.
We examined whether high lactate level in septic patients was associated with 90-day mortality based on the patients' disseminated intravascular coagulation (DIC) status.
We conducted a multicenter, retrospective, observational study of patients admitted to the intensive care unit (ICU) with a suspicion of severe infection and diagnosed with sepsis. Regression analyses were performed to estimate the interaction effect between DIC status and the lactate level. Then, the association between the lactate level and 90-day mortality was assessed in the DIC and non-DIC subgroups.
The data of 415 patients were analyzed. We found a significant interaction between DIC status and the lactate level for predicting 90-day mortality ( = 0.04). Therefore, we performed a subgroup analysis and found that high lactate concentration was significantly associated with 90-day mortality in the DIC group (odds ratio = 2.31, = 0.039) but not in the non-DIC group.
In patients with DIC, a high lactate level significantly predicted 90-day mortality; no such association was found in the non-DIC group. Thus, DIC status may serve as a possible effect modifier of lactate level in predicting mortality in patients with sepsis.
我们基于脓毒症患者的弥散性血管内凝血（DIC）状态，研究了高乳酸水平是否与90天死亡率相关。
我们对入住重症监护病房（ICU）、疑似严重感染并被诊断为脓毒症的患者进行了一项多中心、回顾性观察研究。进行回归分析以估计DIC状态与乳酸水平之间的交互作用。然后，在DIC和非DIC亚组中评估乳酸水平与90天死亡率之间的关联。
分析了415例患者的数据。我们发现DIC状态与乳酸水平之间在预测90天死亡率方面存在显著交互作用（P = 0.04）。因此，我们进行了亚组分析，发现高乳酸浓度在DIC组中与90天死亡率显著相关（比值比 = 2.31，P = 0.039），而在非DIC组中则不然。
在DIC患者中，高乳酸水平显著预测90天死亡率；在非DIC组中未发现这种关联。因此，DIC状态可能是预测脓毒症患者死亡率时乳酸水平的一个可能的效应修饰因素。
