早期乳酸清除率作为脓毒症患者生存的决定因素：来自资源匮乏国家的研究结果

Early Lactate Clearance as a Determinant of Survival in Patients with Sepsis: Findings from a Low-resource Country.

作者信息

Rehman Fazal, Zafar Saad Bin, Aziz Adil, Aziz Abdul, Memon Pirbhat Shams, Ejaz Taymmia, Aziz Summaira

机构信息

Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.

Department of Community Health Sciences, The Aga Khan University Hospital, Karachi, Pakistan.

出版信息

J Crit Care Med (Targu Mures). 2023 Feb 8;9(1):30-38. doi: 10.2478/jccm-2023-0005. eCollection 2023 Jan.

DOI:10.2478/jccm-2023-0005

PMID:36890975

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9987270/

Abstract

BACKGROUND

Single lactate measurements have been reported to have prognostic significance, however, there is a lack of data in local literature from Pakistan. This study was done to determine prognostic role of lactate clearance in sepsis patients being managed in our lower-middle income country.

METHODS

This prospective cohort study was conducted from September 2019-February 2020 at the Aga Khan University Hospital, Karachi. Patients were enrolled using consecutive sampling and categorized based on their lactate clearance status. Lactate clearance was defined as decrease by 10% or greater in repeat lactate from the initial measurement (or both initial and repeat levels <=2.0 mmol/L).

RESULTS

A total 198 patients were included in the study, 51% (101) were male. Multi-organ dysfunction was reported in 18.6% (37), 47.7% (94) had single organ dysfunction, and 33.8% (67) had no organ dysfunction. Around 83% (165) were discharged and 17% (33) died. There were missing data for 25.8% (51) of the patients for the lactate clearance, whereas 55% (108) patients had early lactate clearance and 19.7% (39) had delayed lactate clearance.On univariate analysis, mortality rate was higher in patients with delayed lactate clearance (38.4% vs 16.6%) and patients were 3.12 times (OR = 3.12; [95% CI: 1.37-7.09]) more likely to die as compared with early lactate clearance. Patients with delayed lactate clearance had higher organ dysfunction (79.4% vs 60.1%) and were 2.56 (OR = 2.56; [95% CI: 1.07-6.13]) times likely to have organ dysfunction. On multivariate analysis, after adjusting for age and co-morbids, patients with delayed lactate clearance were 8 times more likely to die than patients with early lactate clearance [aOR = 7.67; 95% CI:1.11-53.26], however, there was no statistically significant association between delayed lactate clearance [aOR = 2.18; 95% CI: 0.87-5.49)] and organ dysfunction.

CONCLUSION

Lactate clearance is a better determinant of sepsis and septic shock effective management. Early lactate clearance is related to better outcomes in septic patients.

摘要

背景

据报道，单次乳酸测量具有预后意义，然而，巴基斯坦当地文献中缺乏相关数据。本研究旨在确定在我们这个中低收入国家接受治疗的脓毒症患者中乳酸清除率的预后作用。

方法

这项前瞻性队列研究于2019年9月至2020年2月在卡拉奇的阿迦汗大学医院进行。采用连续抽样法纳入患者，并根据其乳酸清除率状态进行分类。乳酸清除率定义为重复测量的乳酸水平较初始测量值降低10%或更多（或初始和重复测量值均≤2.0 mmol/L）。

结果

本研究共纳入198例患者，其中51%（101例）为男性。报告有多器官功能障碍的患者占18.6%（37例），有单器官功能障碍的患者占47.7%（94例），无器官功能障碍的患者占33.8%（67例）。约83%（165例）患者出院，17%（33例）患者死亡。25.8%（51例）患者的乳酸清除率数据缺失，而55%（108例）患者早期乳酸清除，19.7%（39例）患者乳酸清除延迟。单因素分析显示，乳酸清除延迟的患者死亡率更高（38.4%对16.6%），与早期乳酸清除的患者相比，死亡可能性高3.12倍（OR = 3.12；[95%CI：1.37 - 7.09]）。乳酸清除延迟的患者器官功能障碍发生率更高（79.4%对60.1%），发生器官功能障碍的可能性高2.56倍（OR = 2.56；[95%CI：1.07 - 6.13]）。多因素分析显示，在调整年龄和合并症后，乳酸清除延迟的患者死亡可能性比早期乳酸清除的患者高8倍[aOR = 7.67；95%CI：1.11 - 53.26]，然而，乳酸清除延迟与器官功能障碍之间无统计学显著关联[aOR = 2.18；95%CI：0.87 - 5.49]。