Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, Jiangxi, 330006, PR China.
BMC Gastroenterol. 2020 Apr 19;20(1):116. doi: 10.1186/s12876-020-01268-1.
The present study aimed to investigate the relationships between arterial lactate levels and outcomes in severe acute pancreatitis.
The study retrospectively analyzed the medical data of 329 patients with severe acute pancreatitis from January 2014 to February 2019. We compared baseline characteristics, laboratory data, severity scores, types of persistent organ failure, and primary and secondary outcomes of patients with and without elevated arterial lactate levels at admission. A multivariate logistic regression analysis model and receiver operating characteristic curve were adopted to evaluate the value of arterial lactate ≥4 mmol/L for identifying high-risk patients. Trends in arterial lactate levels were compared between patients in the survivor and nonsurvivor groups over a period of 7 days.
Compared to normal arterial lactate levels, patients with elevated arterial lactate levels show significantly higher incidences of multiple persistent organ failure (3% vs 30%, P < 0.01), death (2% vs 11%, P < 0.01), septic shock (4% vs 24%, P < 0.01), pancreatic infection (12% vs 37%, P < 0.01), abdominal compartment syndrome (3% vs 20%, P < 0.01), pancreatic necrosis (41% vs 63%, P < 0.01), and a need for ventilator support (26% vs 54%, P < 0.01). For predicting mortality, arterial lactate levels ≥4 mmol/L had a high hazard ratio (10, 95% CI; 3.7-27; P < 0.01) and the highest area under the curve (0.78).
Our results indicate that initially elevated arterial lactate is independently associated with poor outcomes and death in patients with severe acute pancreatitis and may serve as an early high-risk stratification indicator.
本研究旨在探讨动脉血乳酸水平与重症急性胰腺炎患者预后的关系。
回顾性分析 2014 年 1 月至 2019 年 2 月收治的 329 例重症急性胰腺炎患者的临床资料。比较动脉血乳酸水平升高和正常患者的一般资料、实验室指标、严重程度评分、持续性器官衰竭类型及主要和次要结局。采用多因素 logistic 回归分析模型和受试者工作特征曲线评估动脉血乳酸≥4mmol/L 对识别高危患者的价值。对存活组和死亡组患者在 7d 内的动脉血乳酸水平变化趋势进行比较。
与动脉血乳酸水平正常患者相比，动脉血乳酸水平升高患者的多器官持续性衰竭（3%比 30%，P<0.01）、死亡（2%比 11%，P<0.01）、感染性休克（4%比 24%，P<0.01）、胰腺感染（12%比 37%，P<0.01）、腹腔间隔室综合征（3%比 20%，P<0.01）、胰腺坏死（41%比 63%，P<0.01）和需要呼吸机支持（26%比 54%，P<0.01）发生率更高。动脉血乳酸水平≥4mmol/L 预测死亡率的危险比（HR）为 10（95%可信区间为 3.7~27；P<0.01），曲线下面积（AUC）最大（0.78）。
本研究结果表明，重症急性胰腺炎患者入院时动脉血乳酸水平升高与不良预后和死亡独立相关，可作为早期高危分层指标。
