Department of Gastroenterology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey.
Department of Medical Biochemistry, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey.
Ir J Med Sci. 2022 Jun;191(3):1177-1183. doi: 10.1007/s11845-022-02941-y. Epub 2022 Feb 8.
Tokyo guidelines (TG13/18) are used for the severity assessment of acute cholangitis (AC). Lactate is a clinical marker of tissue hypoxia and disease severity, independent from blood pressure.
The aim of this study is to investigate the relationship between blood lactate level and TG13/18 criteria in patients diagnosed with AC.
One hundred fifteen patients with AC were included in this retrospective study. Demographic characteristics of the patients and laboratory data were scanned from their hospital medical records. According to TG13/18 guidelines, the patients were divided into 3 groups as mild (grade 1), moderate (grade 2), and severe (grade 3) AC.
Sixty three (54.7%) of the patients were grade 1, 37 (32.1%) were grade 2, and 15 (13.0%) were grade 3. It was found that blood lactate level increased significantly from grade 1 to grade 3 (p < 0.001). In logistic regression analysis, white blood cell (WBC) count, total bilirubin and blood lactate levels independently determined the patients to be grade 2 or 3 AC. When the blood lactate cut-off value was taken as 16.5 mg/dL, we diagnosed grade 2 or 3 AC with a sensitivity of 78.8% and a specificity of 75.7%. From among lactate, WBC, and C reactive protein, lactate showed the highest value regarding the area under the curve, which is an index for predicting grade III upon ROC analysis.
The blood lactate level is associated with the severity of AC. In addition to TG13/18 guidelines, blood lactate level can be a useful biomarker in the severity grading of AC.
东京指南（TG13/18）用于评估急性胆管炎（AC）的严重程度。乳酸是组织缺氧和疾病严重程度的临床标志物，与血压无关。
本研究旨在探讨诊断为 AC 的患者的血乳酸水平与 TG13/18 标准之间的关系。
本回顾性研究纳入了 115 例 AC 患者。从他们的医院病历中扫描患者的人口统计学特征和实验室数据。根据 TG13/18 指南，将患者分为轻度（1 级）、中度（2 级）和重度（3 级）AC 3 组。
63 例（54.7%）患者为 1 级，37 例（32.1%）为 2 级，15 例（13.0%）为 3 级。结果发现，血乳酸水平从 1 级到 3 级显著升高（p<0.001）。在逻辑回归分析中，白细胞（WBC）计数、总胆红素和血乳酸水平独立确定患者为 2 级或 3 级 AC。当血乳酸截断值为 16.5mg/dL 时，我们诊断 2 级或 3 级 AC 的敏感性为 78.8%，特异性为 75.7%。在乳酸、WBC 和 C 反应蛋白中，乳酸在 ROC 分析中预测 3 级的曲线下面积最高，是预测 AC 严重程度的有用生物标志物。
血乳酸水平与 AC 的严重程度相关。除 TG13/18 指南外，血乳酸水平也可作为 AC 严重程度分级的有用生物标志物。
