Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, China.
Dis Markers. 2022 Nov 9;2022:9233199. doi: 10.1155/2022/9233199. eCollection 2022.
High lactate levels at hospital admission are significantly associated with poor prognosis in acute pancreatitis patients. Early high lactate clearance is a vital marker for predicting persistent organ failure and mortality in critical illness; however, its value in acute pancreatitis remains unclear.
Data were collected from patients who were diagnosed with moderately severe acute pancreatitis and severe acute pancreatitis from January 2017 to December 2020. Initial lactate (within 2 hours after admission) and repeat lactate at 24 hours after admission were measured to determine lactate clearance. Low clearance was defined as a reduction in repeat lactate of less than 30% compared to the first measurement. High clearance was defined as a repeat lactate decrease ≥30% of the first measurement or both first and second lactate levels <2 mmol/L. Baseline data, laboratory data, mortality rate, persistent organ failure rate, and other outcomes such as the incidence of septic pancreatic necrosis and sepsis and the length of hospital stay and intensive care unit (ICU) stay were compared in the low and high lactate clearance groups. Multivariate logistic regression analyses were used to assess the value of lactate clearance for predicting death.
Among 4425 acute pancreatitis patients, 3040 patients were diagnosed with moderate or severe acute pancreatitis, and 1028 patients had initial lactate measured. Finally, 390 patients who had initial and 24-hour repeat lactate data were included in the study. Patients who had elevated initial lactate had poor outcomes, and 51 patients in the initial elevated lactate group died. In the lactate normalization group analysis, 293 patients had 24-hour lactate normalization; compared with patients in the nonnormalization group, they had a lower rate of mortality (12.6% vs. 33%). In the lactate clearance group analysis, 70 (21.9%) patients had a low clearance after 24 hours; compared with patients in the high clearance group, they had a higher rate of developing persistent multiorgan failure ( = 0.045), and the incidence of death was higher (15% vs. 28.6%, = 0.007). Multivariate logistic analysis showed that 24-hour lactate clearance (OR: 2.007; 95% CI:1.032-3.903, = 0.04), elevated initial lactate (OR: 2.011; 95% CI:1.023-3.953, = 0.043), blood urea nitrogen (OR: 2.316; 95% CI:1.061-5.056, = 0.035), and white blood count (OR: 1.982; 95% CI:1.026-3.829, = 0.042) were independent predictors of hospital mortality.
The 24-hour clearance of lactate is a reliable marker to predict the outcome of moderate and severe acute pancreatitis, and low lactate clearance may indicate that the patient's condition will worsen, requiring aggressive treatments to improve patient outcomes.
入院时高乳酸水平与急性胰腺炎患者预后不良显著相关。早期高乳酸清除率是预测危重病患者持续器官衰竭和死亡率的重要标志物；然而，其在急性胰腺炎中的价值尚不清楚。
本研究纳入了 2017 年 1 月至 2020 年 12 月期间被诊断为中度和重度急性胰腺炎的患者。测定入院后 2 小时内的初始乳酸（入院后 2 小时内）和入院后 24 小时的重复乳酸，以确定乳酸清除率。低清除率定义为与第一次测量相比，重复乳酸减少小于 30%。高清除率定义为重复乳酸下降≥30%，或首次和第二次乳酸水平均<2 mmol/L。比较低和高乳酸清除组的基线数据、实验室数据、死亡率、持续性器官衰竭率以及其他结局，如感染性胰腺坏死和脓毒症的发生率、住院时间和重症监护病房（ICU）住院时间。多变量逻辑回归分析用于评估乳酸清除率预测死亡的价值。
在 4425 例急性胰腺炎患者中，3040 例患者被诊断为中度或重度急性胰腺炎，1028 例患者测量了初始乳酸。最终，390 例患者有初始和 24 小时重复乳酸数据，被纳入研究。初始乳酸升高的患者预后不良，初始升高乳酸组中有 51 例患者死亡。在乳酸正常化组分析中，293 例患者在 24 小时内乳酸正常化；与未正常化组相比，死亡率较低（12.6%比 33%）。在乳酸清除组分析中，70 例（21.9%）患者在 24 小时后乳酸清除率低；与高清除率组相比，持续性多器官衰竭发生率更高（ = 0.045），死亡率也更高（15%比 28.6%， = 0.007）。多变量逻辑分析显示，24 小时乳酸清除率（OR：2.007；95%CI：1.032-3.903， = 0.04）、初始乳酸升高（OR：2.011；95%CI：1.023-3.953， = 0.043）、血尿素氮（OR：2.316；95%CI：1.061-5.056， = 0.035）和白细胞计数（OR：1.982；95%CI：1.026-3.829， = 0.042）是住院死亡率的独立预测因素。
24 小时乳酸清除率是预测中重度急性胰腺炎结局的可靠标志物，低乳酸清除率可能表明患者病情恶化，需要积极治疗以改善患者预后。
