肺移植术后72小时内动脉血乳酸峰值水平对判断患者预后的价值。
The prognostic value of peak arterial lactate levels within 72 h of lung transplantation in identifying patient outcome.
作者信息
Xu Jingjing, Qin Zhong, Wang Yanjuan, Hu Chunxiao, Wang Guilong, Gu Zhengfeng, Yuan Shengjie, Chen Jingyu, Huang Dongxiao, Wang Zhiping
机构信息
Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.
Department of Lung Transplant Group, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.
出版信息
J Thorac Dis. 2020 Dec;12(12):7365-7373. doi: 10.21037/jtd-20-3445.
BACKGROUND
Lactic acidosis is often seen in lung transplantation (LTx). Postoperative lactate is frequently associated with poor outcome in postoperative and critically ill patients. Our aim was to evaluate the predictive value of postoperative peak lactate levels within 72 h of LTx for 30-day and late mortality.
METHODS
We evaluated patients who underwent LTx from January 2015 to September 2017. All admitted patients were classified according to the peak lactate level (PL) within 72 h of surgery: PL <5 mmol/L (Group 1); PL =5-10 mmol/L (Group 2), and PL >10 mmol/L (Group 3). We performed logistic regression analysis and used Cox regression models to identify the peak lactate level as a predictive factor for 30-day and late mortality, respectively.
RESULTS
Of 255 eligible patients, mean age 55.61±12.16, mean lactate 4.99±2.93 and 80% male, and 40% had hyperlactatemia (PL >5 mmol/L) after LTx. The 30-day mortality rate was 17.9%, 28.9% and 68.8% in the three groups, respectively (P<0.05). Multivariate regression analyses revealed postoperative PL as a notable predictor of 30-day mortality [odds ratio =2.62 (1.42-4.84), P=0.002] as well as for late mortality [hazard ratio =2.70 (1.13-6.42), P=0.025].
CONCLUSIONS
The postoperative peak lactate level within 72 h of surgery was an independent predictor for 30-day and late mortality in LTx patients.
背景
乳酸性酸中毒在肺移植（LTx）中较为常见。术后乳酸水平常与术后及危重症患者的不良预后相关。我们的目的是评估肺移植术后72小时内的术后峰值乳酸水平对30天及晚期死亡率的预测价值。
方法
我们评估了2015年1月至2017年9月接受肺移植的患者。所有入院患者根据手术72小时内的峰值乳酸水平（PL）进行分类：PL<5 mmol/L（第1组）；PL = 5 - 10 mmol/L（第2组），以及PL>10 mmol/L（第3组）。我们进行了逻辑回归分析，并使用Cox回归模型分别将峰值乳酸水平确定为30天和晚期死亡率的预测因素。
结果
255例符合条件的患者中，平均年龄55.61±12.16，平均乳酸水平4.99±2.93，80%为男性，40%的患者肺移植术后有高乳酸血症（PL>5 mmol/L）。三组的30天死亡率分别为17.9%、28.9%和68.8%（P<0.05）。多变量回归分析显示，术后PL是30天死亡率[比值比 = 2.62（1.42 - 4.84），P = 0.002]以及晚期死亡率[风险比 = 2.70（1.13 - 6.42），P = 0.025]的显著预测因素。
结论
手术72小时内的术后峰值乳酸水平是肺移植患者30天和晚期死亡率的独立预测因素。
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