Surgical Intensive Care Unit, Fujian Provincial Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
BMC Anesthesiol. 2021 Jan 12;21(1):16. doi: 10.1186/s12871-021-01239-3.
An index of dynamic lactate change that incorporates both the magnitude of change and the time interval of such change, termed "normalized lactate load," may reflect the hypoxic burden of septic shock. We aimed to evaluate the association between normalized lactate load and 28-day mortality in adult septic shock patients.
Patients with septic shock were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Lactate load was defined as the sum of the area under the curve (AUC) of serial lactate levels using the trapezoidal rule, and normalized lactate load was defined as the lactate load divided by time. Receiver-operating characteristic curves were constructed to determine the performance of initial lactate, maximum lactate and normalized lactate load in predicting 28-day mortality.
A total of 1371 septic shock patients were included, and the 28-day mortality was 39.8%. Non-survivors had significantly higher initial lactate (means ± standard deviations: 3.9 ± 2.9 vs. 2.8 ± 1.7 mmol/L), maximum lactate (5.8 ± 3.8 vs. 4.3 ± 2.2 mmol/L), lactate load (94.3 ± 71.8 vs. 61.1 ± 36.4 mmol·hr./L) and normalized lactate load (3.9 ± 3.0 vs. 2.5 ± 1.5 mmol/L, all p < 0.001). The AUCs of initial lactate, maximum lactate and normalized lactate load were 0.623 (95% confidence interval: 0.596-0.648, with a cut-off value of 4.4 mmol/L), 0.606 (0.580-0.632, with a cut-off value of 2.6 mmol/L) and 0.681 (0.656-0.706, with a cut-off value of 2.6 mmol/L), respectively. The AUC of normalized lactate load was significantly greater than both initial lactate and maximum lactate (all p < 0.001). In the multivariate logistic regression model, normalized lactate load was identified as an independent risk factor for 28-day mortality.
Normalized lactate load is an independent risk factor for 28-day mortality in adult septic shock patients. Normalized lactate load had better accuracy than both initial and maximum lactate in determining the prognosis of septic shock patients.
一种能够反映脓毒性休克缺氧负担的动态乳酸变化指数，该指数综合了变化幅度和变化时间间隔，称为“归一化乳酸负荷”。我们旨在评估成人脓毒性休克患者中归一化乳酸负荷与 28 天死亡率之间的关系。
从 MIMIC-III 数据库中确定患有脓毒性休克的患者。乳酸负荷定义为使用梯形法则对连续乳酸水平的曲线下面积（AUC）的总和，归一化乳酸负荷定义为乳酸负荷除以时间。构建受试者工作特征曲线以确定初始乳酸、最大乳酸和归一化乳酸负荷在预测 28 天死亡率方面的表现。
共纳入 1371 例脓毒性休克患者，28 天死亡率为 39.8%。幸存者的初始乳酸（平均值±标准差：3.9±2.9 vs. 2.8±1.7mmol/L）、最大乳酸（5.8±3.8 vs. 4.3±2.2mmol/L）、乳酸负荷（94.3±71.8 vs. 61.1±36.4mmol·hr./L）和归一化乳酸负荷（3.9±3.0 vs. 2.5±1.5mmol/L）均显著更高（均 P<0.001）。初始乳酸、最大乳酸和归一化乳酸负荷的 AUC 分别为 0.623（95%置信区间：0.596-0.648，截断值为 4.4mmol/L）、0.606（0.580-0.632，截断值为 2.6mmol/L）和 0.681（0.656-0.706，截断值为 2.6mmol/L）。归一化乳酸负荷的 AUC 明显大于初始乳酸和最大乳酸（均 P<0.001）。在多变量逻辑回归模型中，归一化乳酸负荷被确定为 28 天死亡率的独立危险因素。
归一化乳酸负荷是成人脓毒性休克患者 28 天死亡率的独立危险因素。归一化乳酸负荷在确定脓毒性休克患者预后方面比初始乳酸和最大乳酸更准确。
