Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung.
Chung Shan Medical University, School of Medicine, Taiwan.
Medicine (Baltimore). 2021 Feb 19;100(7):e24474. doi: 10.1097/MD.0000000000024474.
Sepsis is a life-threatening condition, and serum lactate levels have been used to predict patient prognosis. Studies on serum lactate levels in patients undergoing regular hemodialysis who have sepsis are limited. This study aimed to determine the predictive value of serum lactate levels for sepsis-related mortality among patients who underwent last hemodialysis at three different times before admission to the emergency department (ED).This retrospective cohort study was conducted from January 2007 to December 2013 in southern Taiwan. All hemodialysis patients with sepsis, receiving antibiotics within 24 hours of sepsis confirmation, admitted for at least 3 days, and whose serum lactate levels were known were examined to determine the difference in the serum lactate levels of patients who underwent last hemodialysis within 4 hours (Groups A), in 4-12 hours (Group B), and beyond 12 hours (Group C) before visited to the ED. All the continuous variables, categorical variables and mortality were compared by using Kruskal-Wallis test or Mann-Whitney test, the χ2 or Fisher exact tests, and multiple logistic regression model, respectively.A total of 490 patients were enrolled in the study, and 8.0% (39), 21.5% (84), and 74.9% (367) of the patients were in Group A, Group B and Group C, respectively; the serum lactate levels (2.91 vs 2.13 vs 2.79 mmol/L, respectively; P = .175) and 28-day in-hospital mortality (17.9% vs 14.6% vs 22.9%) showed no statistically significant difference between 3 groups. The association between serum lactate levels and 28-day in-hospital mortality was reliable in Group B (P = .002) and Group C (P < .001), but it was unreliable in Group A (P = .629).Serum lactate level has acceptable sensitivity in predicting 28-day in-hospital mortality among patients with sepsis who undergo last hemodialysis after 4 hours, but is not reliable when the last hemodialysis takes place within 4 hours.
脓毒症是一种危及生命的病症，血清乳酸水平已被用于预测患者的预后。目前针对在接受常规血液透析的脓毒症患者的血清乳酸水平进行的研究十分有限。本研究旨在确定在急诊部（ED）就诊前的最后一次血液透析分别在三个不同时间点（4 小时内、4-12 小时内和超过 12 小时）进行的患者中，血清乳酸水平对与脓毒症相关的死亡率的预测价值。这项回顾性队列研究于 2007 年 1 月至 2013 年 12 月在台湾南部进行。所有接受血液透析且在确诊脓毒症后 24 小时内接受抗生素治疗、至少住院 3 天且已知血清乳酸水平的脓毒症患者，其最后一次血液透析时间分别在 4 小时内（A 组）、4-12 小时内（B 组）和超过 12 小时（C 组）的患者，比较其血清乳酸水平的差异。通过 Kruskal-Wallis 检验或 Mann-Whitney 检验、卡方检验或 Fisher 确切检验和多因素逻辑回归模型，分别比较了所有连续变量、分类变量和死亡率。共纳入 490 例患者，A、B、C 组分别为 8.0%（39 例）、21.5%（84 例）和 74.9%（367 例）；三组间血清乳酸水平（分别为 2.91、2.13 和 2.79mmol/L，P=0.175）和 28 天院内死亡率（分别为 17.9%、14.6%和 22.9%）无统计学差异。在 B 组（P=0.002）和 C 组（P<0.001），血清乳酸水平与 28 天院内死亡率之间的相关性可靠，但在 A 组（P=0.629）不可靠。在最后一次血液透析 4 小时后进行的脓毒症患者中，血清乳酸水平对预测 28 天院内死亡率具有可接受的敏感性，但在最后一次血液透析在 4 小时内进行时，其不可靠。
