Mao Zhi, Liu Guoxiong, Yu Qing, Qi Shuang, Lou Yunchi, Liu Chao, Li Qinglin, Xue Chao, Kang Hongjun, Hong Quan, Zhou Feihu
Department of Critical Care Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
Emergency Department, the First Affiliated Hospital of Guizhou University of TCM, Guiyang, China.
Ann Transl Med. 2020 Oct;8(19):1240. doi: 10.21037/atm-20-6317.
To assess the association between serum lactate levels and intolerance to enteral nutrition (EN) in septic patients treated with vasopressors.
This retrospective study was conducted between January 1, 2015 and May 1, 2018 in an intensive care unit (ICU). Patients with sepsis who were given EN and treated with vasopressors were included. EmpowerStats software and R (version 3.3.2) was used to examine the association between serum lactate levels and intolerance to EN.
Among the 132 septic patients (age, 60.6±18.1 years) enrolled, 35 (26.5%) patients suffered intolerance to EN. Multiple logistic regression analysis demonstrated that an elevated lactate level was an independent risk factor for EN intolerance [odds ratio (OR): 2.7; 95% confidence interval (CI): 1.6-4.4; P<0.001]. The area under the receiver operating characteristic (ROC) curve for serum lactate levels was 0.764 (95% CI: 0.664-0.864). Stratified analysis suggested that age was the most prominent interactive factor for serum lactate levels in EN intolerance. Serum lactate levels were closely correlated to EN intolerance in elderly patients (age ≥65 years) (OR: 9.5; 95% CI: 2.1-42.4; P=0.0261 for interaction), while no such association was identified in younger patients (age <65 years; OR: 1.7; 95% CI: 1.0-2.9; P=0.052).
Serum lactate levels were associated with an increased risk of EN intolerance in patients with sepsis, especially in elderly individuals. An elevated serum lactate level may be an early predictor of EN intolerance in elderly septic patients treated with vasopressors. However, further studies are called for to verify these findings.
评估接受血管升压药治疗的脓毒症患者血清乳酸水平与肠内营养不耐受之间的关联。
本回顾性研究于2015年1月1日至2018年5月1日在一家重症监护病房（ICU）进行。纳入接受肠内营养并接受血管升压药治疗的脓毒症患者。使用EmpowerStats软件和R（版本3.3.2）来检验血清乳酸水平与肠内营养不耐受之间的关联。
在纳入的132例脓毒症患者（年龄60.6±18.1岁）中，35例（26.5%）患者出现肠内营养不耐受。多因素逻辑回归分析表明，乳酸水平升高是肠内营养不耐受的独立危险因素[比值比（OR）：2.7；95%置信区间（CI）：1.6 - 4.4；P < 0.001]。血清乳酸水平的受试者工作特征（ROC）曲线下面积为0.764（95%CI：0.664 - 0.864）。分层分析表明，年龄是肠内营养不耐受中血清乳酸水平最显著的交互因素。老年患者（年龄≥65岁）血清乳酸水平与肠内营养不耐受密切相关（OR：9.5；95%CI：2.1 - 42.4；交互作用P = 0.0261），而年轻患者（年龄<65岁）未发现此类关联（OR：1.7；95%CI：1.0 - 2.9；P = 0.052）。
血清乳酸水平与脓毒症患者肠内营养不耐受风险增加相关，尤其是在老年患者中。血清乳酸水平升高可能是接受血管升压药治疗的老年脓毒症患者肠内营养不耐受的早期预测指标。然而，需要进一步研究来验证这些发现。
