Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham, United Kingdom.
Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
Pediatr Crit Care Med. 2022 Jun 1;23(6):e268-e276. doi: 10.1097/PCC.0000000000002904. Epub 2022 Feb 28.
To investigate the relationship between ICU admission blood lactate, base excess, and ICU mortality and to explore the effect of incorporating blood lactate into the Pediatric Index of Mortality.
Retrospective cohort study based on data prospectively collected on every PICU admission submitted to the U.K. Pediatric Intensive Care Audit Network and to the Australia and New Zealand Pediatric Intensive Care Registry.
Thirty-three PICUs in the United Kingdom/Republic of Ireland and nine PICUs and 20 general ICUs in Australia and New Zealand.
All ICU admissions between January 1, 2012, and December 31, 2015.
None.
One hundred twenty-three thousand two hundred fifty-two admissions were recorded in both datasets; 81,576 (66.2%) in the United Kingdom/Republic of Ireland and 41,676 (33.8%) in Australia and New Zealand. Of these 75,070 (61%) had a base excess recorded, 63,316 (51%) had a lactate recorded, and 60,876 (49%) had both base excess and lactate recorded. Median lactate value was 1.5 mmol/L (interquartile range, 1-2.4 mmol/L) (United Kingdom/Republic of Ireland: 1.5 [1-2.5]; Australia and New Zealand: 1.4 [1-2.3]). Children with a lactate recorded had a higher illness severity, were more likely to be invasively ventilated, admitted after cardiac surgery, and had a higher mortality rate, compared with admissions with no lactate recorded (p < 0.001). The relationship between lactate and mortality was stronger (odds ratio, 1.32; 95% CI, 1.31-1.34) than between absolute base excess and mortality (odds ratio, 1.13; 95% CI, 1.12-1.14). Addition of lactate to the Pediatric Index of Mortality score led to a small improvement in performance over addition of absolute base excess, whereas adding both lactate and absolute base excess achieved the best performance.
At PICU admission, blood lactate is more strongly associated with ICU mortality than absolute base excess. Adding lactate into the Pediatric Index of Mortality model may result in a small improvement in performance. Any improvement in Pediatric Index of Mortality performance must be balanced against the added burden of data capture when considering potential incorporation into the Pediatric Index of Mortality model.
研究 ICU 入院血乳酸、碱剩余与 ICU 死亡率之间的关系，并探讨将血乳酸纳入儿科死亡率指数的效果。
基于英国儿科重症监护网络和澳大利亚及新西兰儿科重症监护登记处前瞻性收集的每例 PICU 入院数据进行的回顾性队列研究。
英国/爱尔兰的 33 个 PICU 和澳大利亚及新西兰的 9 个 PICU 和 20 个普通 ICU。
2012 年 1 月 1 日至 2015 年 12 月 31 日期间所有 ICU 入院患者。
无。
两个数据集共记录了 123252 例入院患者；英国/爱尔兰 81576 例（66.2%），澳大利亚及新西兰 41676 例（33.8%）。其中 75070 例（61%）记录了碱剩余，63316 例（51%）记录了乳酸，60876 例（49%）同时记录了碱剩余和乳酸。中位乳酸值为 1.5mmol/L（四分位距，1-2.4mmol/L）（英国/爱尔兰：1.5[1-2.5]；澳大利亚及新西兰：1.4[1-2.3]）。与未记录乳酸的入院患者相比，记录了乳酸的患者疾病严重程度更高，更可能接受有创通气、心脏手术后入院，死亡率更高（p<0.001）。乳酸与死亡率的关系强于绝对碱剩余（比值比，1.32；95%置信区间，1.31-1.34）（比值比，1.13；95%置信区间，1.12-1.14）。将乳酸纳入儿科死亡率指数评分后，其性能比单独纳入绝对碱剩余略有提高，而同时纳入乳酸和绝对碱剩余则可获得最佳性能。
在 PICU 入院时，血乳酸与 ICU 死亡率的相关性强于绝对碱剩余。将乳酸纳入儿科死亡率指数模型可能会略微提高其性能。在考虑将其纳入儿科死亡率指数模型时，任何对儿科死亡率指数性能的改进都必须权衡数据采集的额外负担。
