Yu Gina, Yoo Seung Joon, Lee Sang-Hun, Kim June Sung, Jung Sungmin, Kim Youn-Jung, Kim Won Young, Ryoo Seung Mok
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Acute Crit Care. 2019 May;34(2):126-132. doi: 10.4266/acc.2018.00283. Epub 2019 Apr 12.
The current Surviving Sepsis Campaign guidelines recommend the remeasurement of lactate levels if the initial lactate level is elevated; however, the prognostic value of lactate kinetics is limited and inconsistent. We attempted to determine the efficacy of the lactate area score (calculated from repeated lactate measurements during initial resuscitation) as a prognostic marker of septic shock in the emergency department (ED).
We performed a retrospective study of adult patients with septic shock in the ED of a single tertiary medical center. Serial lactate levels were measured five times within 12 hours. We also compared the initial lactate level, maximum lactate level, and lactate area score. The lactate area score was defined as the sum of the area under the curve measured at 2, 4, 6, and 12 hours following the initial measurement.
A total of 362 patients were enrolled in this study, and the overall 28-day mortality was 31.8%. The lactate area score of serial lactate levels as well as the initial (median [interquartile range], 4.9 [3.4 to 10.5]; P=0.003) and maximum (7.3 [4.2 to 13.2]; P<0.001) lactate levels were significantly higher in the non-survivor group. However, in multivariate analysis, only the lactate area score (odds ratio, 1.013; 95% confidence interval, 1.007 to 1.019) was significantly associated with 28-day mortality.
The early lactate area score may be a possible prognostic marker for predicting the 28-day mortality of adult septic shock patients. Further prospective interventional studies should be conducted to validate our results.
当前的《拯救脓毒症运动指南》建议，如果初始乳酸水平升高，则重新测量乳酸水平；然而，乳酸动力学的预后价值有限且不一致。我们试图确定乳酸面积评分（根据初始复苏期间重复测量的乳酸计算得出）作为急诊科（ED）感染性休克预后标志物的有效性。
我们对一家单一的三级医疗中心急诊科的成年感染性休克患者进行了一项回顾性研究。在12小时内对乳酸水平进行了5次连续测量。我们还比较了初始乳酸水平、最高乳酸水平和乳酸面积评分。乳酸面积评分定义为初始测量后2、4、6和12小时测量的曲线下面积之和。
本研究共纳入362例患者，总体28天死亡率为31.8%。非存活组的连续乳酸水平的乳酸面积评分以及初始（中位数[四分位间距]，4.9[3.4至10.5]；P = 0.003）和最高（7.3[4.2至13.2]；P < 0.001）乳酸水平显著更高。然而，在多变量分析中，只有乳酸面积评分（优势比，1.013；95%置信区间，1.007至1.019）与28天死亡率显著相关。
早期乳酸面积评分可能是预测成年感染性休克患者28天死亡率的一个可能的预后标志物。应进行进一步的前瞻性干预研究以验证我们的结果。
