Department of Critical Care Medicine, Fujian Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No 134, Dongjie Street, Gulou District, Fuzhou, 350001, Fujian, China.
BMC Anesthesiol. 2022 Mar 25;22(1):79. doi: 10.1186/s12871-022-01617-5.
The present study aimed to evaluate the association between normalized lactate load, an index that incorporates the magnitude of change and the time interval of such evolution of lactate, and 28-day mortality in sepsis and non-sepsis patients. We also compared the accuracy of normalized lactate load in predicting mortality between these two populations.
Data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. We defined lactate load as the sum of the area under the lactate concentration curve; we also defined normalized lactate load as the lactate load divided by time. The performance of maximum lactate, mean lactate and normalized lactate load in predicting 28-day mortality in sepsis and non-sepsis patients were compared by receiver-operating characteristic curves analysis.
A total of 21,333 patients were included (4219 sepsis and 17,114 non-sepsis patients). Non-survivors had significantly higher normalized lactate load than survivors in sepsis and non-sepsis patients. The maximum lactate, mean lactate, and normalized lactate load AUCs were significantly greater in sepsis patients than in non-sepsis patients. Normalized lactate load had the greatest AUCs in predicting 28-day mortality in both sepsis and non-sepsis patients. Sensitivity analysis showed that the AUC of normalized lactate load increased in non-sepsis patients when more lactate measurement was obtained, but it was not improved in sepsis patients.
Normalized lactate load has the strongest predictive power compared with maximum or mean lactate in both sepsis and non-sepsis patients. The accuracy of normalized lactate load in predicting mortality is better in sepsis patients than in non-sepsis patients.
本研究旨在评估乳酸负荷标准化（一种综合了乳酸变化幅度和变化时间间隔的指数）与脓毒症和非脓毒症患者 28 天死亡率之间的关系。我们还比较了这两种人群中乳酸负荷标准化预测死亡率的准确性。
从医疗信息镜架第四版（MIMIC-IV）数据库中提取数据。我们将乳酸负荷定义为乳酸浓度曲线下面积的总和；我们还将乳酸负荷标准化定义为乳酸负荷除以时间。通过接受者操作特征曲线分析比较最大乳酸、平均乳酸和乳酸负荷标准化在预测脓毒症和非脓毒症患者 28 天死亡率方面的性能。
共纳入 21333 例患者（4219 例脓毒症和 17114 例非脓毒症患者）。脓毒症患者中，死亡患者的乳酸负荷标准化明显高于存活患者。脓毒症患者的最大乳酸、平均乳酸和乳酸负荷标准化 AUC 均显著大于非脓毒症患者。乳酸负荷标准化在预测脓毒症和非脓毒症患者 28 天死亡率方面具有最大 AUC。敏感性分析表明，当获得更多乳酸测量值时，非脓毒症患者的乳酸负荷标准化 AUC 增加，但脓毒症患者的 AUC 并未改善。
与最大或平均乳酸相比，乳酸负荷标准化在脓毒症和非脓毒症患者中均具有最强的预测能力。乳酸负荷标准化在预测死亡率方面在脓毒症患者中的准确性优于非脓毒症患者。
