From the Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam (TKO, I-AS, Y-TJ) and Department of Anaesthesiology and Pain Medicine, Seoul National University, Seoul, South Korea (Y-TJ).
Eur J Anaesthesiol. 2020 Jan;37(1):31-37. doi: 10.1097/EJA.0000000000001117.
There is inadequate information on the association of pre-operative and postoperative peak level of lactate with mortality of surgical ICU patients.
To investigate the association between peri-operative lactate level and 90-day mortality in patients admtted to the surgical ICU.
Retrospective cohort study.
ICUs in single tertiary academic hospital.
Adult patients postoperatively admitted to the ICU between January 2012 and December 2017.
None.
Hazard ratios of 90-day mortality according to the following serum lactate levels were assessed: pre-operative lactate level; peak lactate levels on postoperative day (POD) 0 to 3; and delta values of the lactate level on POD 0 to 3 from pre-operative lactate level. Multivariable Cox regression and receiver operating characteristic analyses were used.
Overall 9248 patients were included, among whom 2511, 8690 and 1958 had measured pre-operative lactate levels, lactate levels within POD 0 to 3, and lactate levels measured at both timepoints, respectively. When the peak lactate level on POD 0 to 3 and delta lactate level all increased by 1 mmol l, 90-day mortality increased by 15% [hazard ratio: 1.15; 95% confidence interval (CI) 1.11 to 1.19; P < 0.001] and 14% (hazard ratio: 1.14; 95% CI 1.11 to 1.18; P < 0.001), respectively; the pre-operative lactate level was not significantly associated with 90-day mortality (P = 0.069). The area under the curve for peak level of lactate on POD 0 to 3 (0.72, 95% CI 0.70 to 0.74) was higher than that of pre-operative lactate level (0.58, 95% CI 0.56 to 0.60) in the receiver operating characteristic analysis.
In patients admitted postoperatively to the ICU, higher peri-operative lactate levels were associated with increased 90-day mortality. The peak level of lactate during POD 0 to 3 showed the most significant contribution to this association.
目前关于手术 ICU 患者术前和术后乳酸峰水平与死亡率之间的关系，信息不足。
探讨外科 ICU 患者围手术期乳酸水平与 90 天死亡率之间的关系。
回顾性队列研究。
单所三级学术医院的 ICU。
2012 年 1 月至 2017 年 12 月术后入住 ICU 的成年患者。
无。
根据以下血清乳酸水平评估 90 天死亡率的风险比：术前乳酸水平；术后第 0 至 3 天的乳酸峰值水平；以及第 0 至 3 天乳酸水平与术前乳酸水平的差值。采用多变量 Cox 回归和受试者工作特征分析。
共纳入 9248 例患者，其中 2511、8690 和 1958 例分别测量了术前乳酸水平、第 0 至 3 天的乳酸水平和两个时间点的乳酸水平。当第 0 至 3 天的乳酸峰值和乳酸差值均增加 1mmol/L 时，90 天死亡率分别增加 15%[风险比：1.15；95%置信区间（CI）1.11 至 1.19；P<0.001]和 14%（风险比：1.14；95%CI 1.11 至 1.18；P<0.001）；术前乳酸水平与 90 天死亡率无显著相关性（P=0.069）。在受试者工作特征分析中，第 0 至 3 天乳酸峰值的曲线下面积（0.72，95%CI 0.70 至 0.74）高于术前乳酸水平（0.58，95%CI 0.56 至 0.60）。
在术后入住 ICU 的患者中，较高的围手术期乳酸水平与 90 天死亡率增加相关。第 0 至 3 天的乳酸峰值对这种相关性的贡献最大。
