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血乳酸在预测新生儿败血症预后中的临床价值

[Clinical value of blood lactate in predicting the prognosis of neonatal sepsis].

作者信息

Sun Yu-Shan, Yu Jia-Lin

机构信息

Pediatric Research Institute, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China. yujialin486@ 126.com.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2019 Jul;21(7):629-634. doi: 10.7499/j.issn.1008-8830.2019.07.003.

Abstract

OBJECTIVE

To explore the clinical value of arterial blood lactate level in predicting the prognosis of neonatal sepsis.

METHODS

The clinical data of 301 cases of neonatal sepsis were collected, which mainly included biochemical indicators such as blood lactate on admission, C-reactive protein, and procalcitonin. ROC curves were plotted to evaluate the value of lactate level on admission in predicting the prognosis of neonatal sepsis.

RESULTS

The mortality rate was significantly higher for full-term infants in the severely-elevated lactate group than in the mildly-elevated lactate group and the normal lactate group (26.1% vs 3.1% and 0%; P<0.017). The poor prognosis group had a significantly increased lactate level on admission compared with the good prognosis group (6.5±5.1 mmol/L vs 3.6±1.7 mmol/L; P<0.05). The sensitivity and specificity of blood lactate level on admission (cutoff value: 6.15 mmol/L) were 0.545 and 0.919 respectively, in predicting the prognosis of neonatal sepsis.

CONCLUSIONS

Early blood lactate level can be used as a biochemical parameter to predict the prognosis of neonatal sepsis as it has a high specificity but a low sensitivity.

摘要

目的

探讨动脉血乳酸水平对预测新生儿败血症预后的临床价值。

方法

收集301例新生儿败血症的临床资料,主要包括入院时的血乳酸、C反应蛋白、降钙素原等生化指标。绘制ROC曲线以评估入院时乳酸水平对预测新生儿败血症预后的价值。

结果

乳酸严重升高组足月儿的死亡率显著高于乳酸轻度升高组和乳酸正常组(26.1% 对3.1% 和0%;P<0.017)。与预后良好组相比,预后不良组入院时乳酸水平显著升高(6.5±5.1 mmol/L对3.6±1.7 mmol/L;P<0.05)。入院时血乳酸水平(临界值:6.15 mmol/L)预测新生儿败血症预后的敏感度和特异度分别为0.545和0.919。

结论

早期血乳酸水平可作为预测新生儿败血症预后的生化指标,其特异度高但敏感度低。

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本文引用的文献

4
Lactate and Immunosuppression in Sepsis.脓毒症中的乳酸与免疫抑制。
Shock. 2018 Feb;49(2):120-125. doi: 10.1097/SHK.0000000000000958.
5
C reactive protein in healthy term newborns during the first 48 hours of life.健康足月儿出生后48小时内的C反应蛋白
Arch Dis Child Fetal Neonatal Ed. 2018 Mar;103(2):F163-F166. doi: 10.1136/archdischild-2016-312506. Epub 2017 Jun 30.
6
Neonatal sepsis.新生儿败血症。
Lancet. 2017 Oct 14;390(10104):1770-1780. doi: 10.1016/S0140-6736(17)31002-4. Epub 2017 Apr 20.

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