Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Shuaifuyuan, Wangfujing, Dongcheng district, Beijing, 100730, China.
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA.
BMC Anesthesiol. 2021 Jan 22;21(1):25. doi: 10.1186/s12871-021-01237-5.
Serum lactate has long been used to evaluate hypoxia and predict prognosis in critically ill patients, however, discrepancy in lactate measurements between different sites have not been recognized as a useful tool for monitoring hypoxia and evaluating outcome.
Data were obtained from the clinical information system of the intensive care unit (ICU) in a tertiary academic hospital for 1582 ICU patients with vasoactive drug requirement and valid paired blood gas. The mortality rates were compared between patients with sustained negative venous to arterial lactate gradient (VALac) and the others using the Cox proportional hazard model. Predictive factors associated with negative VALac were searched.
A sustained negative VALac was significantly associated with higher 30 day ICU mortality [Adjusted hazard ratio (HR) = 2.31, 95% confidence interval (CI), 1.07-4.99; p = 0.032. Propensity score- weighted HR: 2.57; 95% CI, 1.17-5.64; p = 0.010]. Arterial lactate in the first blood gas pair, 24-h arterial lactate clearance, use of epinephrine, mean positive end-expiratory pressure level, and extracorporeal membrane oxygenation initiation showed statistically significant association with sustained negative VALac during the first 24 h.
The sustained negative VALac in the early stage of treatment may suggest additional information about tissue hypoxia than arterial lactate alone. Critical care physicians should pay more attention to the lactate discrepancy between different sites in their clinical practice.
血清乳酸一直被用于评估危重病患者的缺氧情况并预测预后，但不同部位之间的乳酸测量值差异尚未被视为监测缺氧和评估结果的有用工具。
从一家三级学术医院的重症监护病房（ICU）的临床信息系统中获取了 1582 例需要血管活性药物且有有效配对血气的 ICU 患者的数据。使用 Cox 比例风险模型比较了持续静脉-动脉乳酸梯度（VALac）阴性和其他患者的死亡率。搜索了与负 VALac 相关的预测因素。
持续的负 VALac 与较高的 30 天 ICU 死亡率显著相关[调整后的危险比（HR）=2.31，95%置信区间（CI），1.07-4.99；p=0.032。倾向评分加权 HR：2.57；95%CI，1.17-5.64；p=0.010]。第一份血气对的动脉乳酸、24 小时动脉乳酸清除率、肾上腺素的使用、平均呼气末正压水平和体外膜氧合的启动与前 24 小时内持续负 VALac 有统计学显著关联。
治疗早期持续的负 VALac 可能比单独的动脉乳酸提供更多关于组织缺氧的信息。重症监护医师在临床实践中应更加注意不同部位之间的乳酸差异。
