Chen Xiaobin, Zhang Jianzheng, Zhang Yang, Lin Yiyun, Liu Zhi, Wang Xiaowei, Sun Tiansheng
Department of Orthopaedics, Beijing Tongren Hospital, Capital Medical University Beijing 100730, China.
Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital Beijing 100700, China.
Am J Transl Res. 2021 Sep 15;13(9):10363-10371. eCollection 2021.
To determine whether serum lactate concentration on admission to hospital is a predictor for 30-day and 1-year mortality for patients who underwent hip-surgery.
Data from elderly patients with hip fractures admitted to our hospital (Jan 2012-Dec 2016) were reviewed. The lactate concentration on admission was assessed using a cut-off value of 2.0 mmol/L and then a new cut-off value was determined by maximizing the Youden index. Multivariate logistic regression was employed to verify whether a higher lactate concentration compared with the cutoff value was an independent risk factor for postoperative mortality after 30 days or at 1 year.
A total of 1,004 patients were enrolled. There were differences in the incidence of postoperative complications (28.6% 21.9%, =0.022), length of stay (13.56±8.66 12.47±7.81 days, =0.047), 30-day mortality (10.8% 1.3%, <0.001), 1-year mortality (23.3% 11.8%, <0.001) and survival time (23.92±16.58 28.81±16.54 months, <0.001) between the ≥2.0 mmol/L (n=315) and <2 mmol/L (n=689) groups. Serum lactate concentration was a good predictor of 30-day mortality (AUC=0.829, <0.001) with a cutoff value of lactate =2.35 mmol/L (sensitivity =0.744, specificity =0.834). Multivariate analysis revealed that a serum lactate concentration ≥2.35 mmol/L at admission was an independent risk factor for 30-day (OR=9.93, <0.001) and 1-year (OR=2.23, <0.001) mortality.
The admission lactate concentration (≥2.35 mmol/L) following hip fracture derived by this study was a significant predictor of mortality 30 days after surgery, which might help physicians to stratify the risk for these patients.
确定髋部手术患者入院时的血清乳酸浓度是否为30天和1年死亡率的预测指标。
回顾了我院（2012年1月至2016年12月）收治的老年髋部骨折患者的数据。采用2.0 mmol/L的临界值评估入院时的乳酸浓度，然后通过最大化约登指数确定新的临界值。采用多因素逻辑回归分析来验证与临界值相比更高的乳酸浓度是否为术后30天或1年死亡率的独立危险因素。
共纳入1004例患者。≥2.0 mmol/L组（n = 315）和<2 mmol/L组（n = 689）在术后并发症发生率（28.6%对21.9%，P = 0.022）、住院时间（13.56±8.66天对12.47±7.81天，P = 0.047）、30天死亡率（10.8%对1.3%，P<0.001）、1年死亡率（23.3%对11.8%，P<0.001）以及生存时间（23.92±16.58个月对28.81±16.54个月，P<0.001）方面存在差异。血清乳酸浓度是30天死亡率的良好预测指标（AUC = 0.829，P<0.001），乳酸临界值为2.35 mmol/L（敏感性 = 0.744，特异性 = 0.834）。多因素分析显示，入院时血清乳酸浓度≥2.35 mmol/L是30天（OR = 9.93，P<0.001）和1年（OR = 2.23，P<0.001）死亡率的独立危险因素。
本研究得出的髋部骨折后入院时乳酸浓度（≥2.35 mmol/L）是术后30天死亡率的重要预测指标，这可能有助于医生对这些患者进行风险分层。
