Ewha Womans University Seoul Hospital, Department of Emergency Medicine, College of Medicine, Ewha Womans University, 260, Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea.
Department of Emergency Medicine College of Medicine Chung-Ang University Gwangmyeong Hospital, Chung-Ang University, 110, Deokan-ro, Gwangmyeong-si, Seoul, Gyeonggi-do, Republic of Korea.
Ir J Med Sci. 2023 Aug;192(4):1923-1929. doi: 10.1007/s11845-022-03185-6. Epub 2022 Oct 13.
Acute gastrointestinal bleeding (GI bleeding) can range from mild symptoms to life-threatening conditions that require emergency intervention. Therefore, it is important to first identify the high-risk and low-risk patients in the emergency department (ED).
This study aimed to investigate the usefulness of a three-hourly interval for determining the lactate clearance, which is shorter than the time interval in previous studies, in order to predict the prognosis early in patients with GI bleeding.
This retrospective study involved patients who visited for complaining of GI bleeding symptoms. Initial lactate levels were measured upon arrival at the ED and measured again 3 h later after performing initial resuscitation. And 3-h lactate clearance was calculated. Lactate and 3-h lactate clearance for predicting outcomes were evaluated by the area under the receiver operating characteristic (AUROC) curve.
A total of 104 patients were enrolled and 21 patients (20.2%) died in the hospital. Multivariate logistic regression showed that 3-h lactate clearance was a significant predictor of in-hospital mortality. The AUROC of 3-h lactate clearance for predicting in-hospital mortality was 0.756. The sensitivity and specificity were 66.67% and 75.90%. On combining lactate clearance, total bilirubin, and PTT, the AUROC was 0.899 for predicting in-hospital mortality.
This study validated that lactate clearance at three-hourly intervals is useful for early prediction of mortality and prognosis in patients with GI bleeding. It is important to perform not only an initial lactate measurement, but also a follow-up lactate measurement after initial resuscitation to check the lactate clearance.
急性胃肠道出血（GI 出血）的症状范围从轻微到危及生命，需要紧急干预。因此，首先在急诊科（ED）识别高危和低危患者非常重要。
本研究旨在探讨每三小时间隔测量乳酸清除率的有用性，这比以前研究中的时间间隔更短，以便早期预测 GI 出血患者的预后。
本回顾性研究纳入了因 GI 出血症状就诊的患者。在到达 ED 时测量初始乳酸水平，并在进行初始复苏后 3 小时再次测量。计算 3 小时乳酸清除率。通过受试者工作特征（ROC）曲线下面积（AUROC）评估乳酸和 3 小时乳酸清除率对预测结果的作用。
共纳入 104 例患者，其中 21 例（20.2%）在医院死亡。多变量逻辑回归显示，3 小时乳酸清除率是住院死亡率的显著预测因素。3 小时乳酸清除率预测住院死亡率的 AUROC 为 0.756。灵敏度和特异性分别为 66.67%和 75.90%。在结合乳酸清除率、总胆红素和 PTT 后，预测住院死亡率的 AUROC 为 0.899。
本研究验证了每三小时间隔测量乳酸清除率可用于早期预测 GI 出血患者的死亡率和预后。不仅要进行初始乳酸测量，还要在初始复苏后进行后续乳酸测量以检查乳酸清除率。
