Miller Taylor, Emamian Nikki, Glick Zoe, Chen Nelson, Cao Tiffany, Buganu Adelina, Cardona Stephanie, Teeter William, Haase Daniel J, Tran Quincy K
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America.
University of Maryland, College Park, MD, United States of America.
Am J Emerg Med. 2022 Oct;60:96-100. doi: 10.1016/j.ajem.2022.07.042. Epub 2022 Jul 22.
Patients who present in shock have high expected mortality and early resuscitation is crucial to improve their outcomes. The Critical Care Resuscitation Unit (CCRU) is a specialized unit at the University of Maryland Medical Center (UMMC) that prioritizes early resuscitation of critically ill patients. We hypothesized that lactate clearance and reduction of Sequential Organ Failure Assessment (SOFA) score during CCRU stay would be associated with lower in-hospital mortality.
We performed a retrospective analysis of adult patients who were admitted to the CCRU between 01/01/2018-12/31/2018 and had a diagnosis of severe shock, determined by serum lactate ≥4 mmol/L. We excluded patients who died during CCRU stay. We used multivariable logistic regression to evaluate the association between lactate clearance and reduction in SOFA scores during CCRU stay and in-hospital mortality.
Out of 1740 patients admitted to the CCRU in 2018, 172 (10%) had serum lactate ≥4 mmol/L. Twenty-two (13%) patients died during their CCRU stay. Our primary analysis included 129 patients with lactate clearance data and 136 patients with SOFA data. Average patients' age was 54 years, and median length of stay in the CCRU was 6 h 55 min. The average lactate and SOFA score on admission were 7.4 (3.8) mmol/L and 8.3 (4.7), respectively. Average lactate clearance was 1.9 (3.1) and average SOFA score reduction was 0.2 (2.9). In multivariable logistic regressions evaluating SOFA score and lactate separately, SOFA score reduction during CCRU stay was associated with lower in-hospital mortality (OR 0.83, 95% CI: 0.70-0.97) but lactate clearance was not (OR 0.90, 95% CI 0.78-1.03). In forward stepwise multivariable analysis containing both SOFA score and lactate values, SOFA score clearance during CCRU stay was still associated with decreased in-hospital mortality (OR 0.84, 95% CI 0.72-0.98).
Care in the CCRU is more effective at reducing lactate than SOFA scores in patients with severe shock. However, SOFA score reduction in the resuscitation phase during the CCRU stay was associated with decreased odds of in-hospital mortality in this group of patients. Further studies are necessary to confirm our observations.
出现休克的患者预期死亡率很高，早期复苏对于改善其预后至关重要。重症监护复苏病房（CCRU）是马里兰大学医学中心（UMMC）的一个专门科室，其重点是对重症患者进行早期复苏。我们假设在CCRU住院期间乳酸清除率和序贯器官衰竭评估（SOFA）评分的降低与较低的院内死亡率相关。
我们对2018年1月1日至2018年12月31日期间入住CCRU且诊断为严重休克（血清乳酸≥4 mmol/L确定）的成年患者进行了回顾性分析。我们排除了在CCRU住院期间死亡的患者。我们使用多变量逻辑回归来评估CCRU住院期间乳酸清除率和SOFA评分降低与院内死亡率之间的关联。
2018年入住CCRU的1740例患者中，172例（10%）血清乳酸≥4 mmol/L。22例（13%）患者在CCRU住院期间死亡。我们的主要分析包括129例有乳酸清除率数据的患者和136例有SOFA数据的患者。患者平均年龄为54岁，在CCRU的中位住院时间为6小时55分钟。入院时平均乳酸和SOFA评分为7.4（3.8）mmol/L和8.3（4.7），分别。平均乳酸清除率为1.9（3.1），平均SOFA评分降低为0.2（2.9）。在分别评估SOFA评分和乳酸的多变量逻辑回归中，CCRU住院期间SOFA评分降低与较低的院内死亡率相关（OR 0.83，95 % CI：0.70 - 0.97），但乳酸清除率无关（OR 0.90，95 % CI 0.78 - 1.03）。在包含SOFA评分和乳酸值的向前逐步多变量分析中，CCRU住院期间SOFA评分降低仍与院内死亡率降低相关（OR 0.84，95 % CI 0.72 - 0.98）。
对于严重休克患者，CCRU的治疗在降低乳酸方面比降低SOFA评分更有效。然而，在CCRU住院期间复苏阶段SOFA评分降低与该组患者院内死亡几率降低相关。需要进一步研究来证实我们的观察结果。
