Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Division of Neurology, Department of Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan.
Infect Dis (Lond). 2023 Aug;55(8):576-584. doi: 10.1080/23744235.2023.2223273. Epub 2023 Jun 19.
Serum lactate is a potentially valuable biomarker for risk assessment for patients with sepsis, as hyperlactatemia is associated with elevated short-term mortality risks. However, the associations between hyperlactatemia and long-term clinical outcomes in sepsis survivors remain unknown. The objective of this study was to investigate whether hyperlactatemia at the time of hospitalisation for sepsis was associated with worse long-term clinical outcomes in sepsis survivors.
In total, of 4983 sepsis survivors aged ≥ 20 years were enrolled in this study between January 1, 2012, and December 31, 2018. They were divided into low (≤18 mg/dL; = 2698) and high (>18 mg/dL; = 2285) lactate groups. The high lactate group was then matched 1:1 by propensity-score method to the low lactate group. The outcomes of interest were all-cause mortality, major adverse cardiac events (MACEs), ischaemic stroke, myocardial infarction, hospitalisation for heart failure, and end-stage renal disease.
After propensity score matching, the high lactate group had greater risks of all-cause mortality (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.41-1.67), MACEs (HR 1.53, 95% CI 1.29-1.81), ischaemic stroke (HR 1.47, 95% CI 1.19-1.81), myocardial infarction (HR 1.52, 95% CI 1.17-1.99), and end-stage renal disease (HR 1.42, 95% CI 1.16-1.72). Subgroup analyses stratified by baseline renal function revealed almost similarity across groups.
We found that hyperlactatemia is associated with long-term risks of mortality and MACEs in sepsis survivors. Physicians may consider more aggressive and prompter management of sepsis in patients who present with hyperlactatemia to improve long-term prognoses.
血清乳酸是评估脓毒症患者风险的一种有潜在价值的生物标志物，因为高乳酸血症与短期死亡率升高有关。然而，脓毒症幸存者中高乳酸血症与长期临床结局之间的关系尚不清楚。本研究的目的是探讨脓毒症患者住院时的高乳酸血症是否与脓毒症幸存者的长期临床结局较差有关。
本研究共纳入了 2012 年 1 月 1 日至 2018 年 12 月 31 日期间年龄≥20 岁的 4983 例脓毒症幸存者。他们被分为低（≤18mg/dL；n=2698）和高（>18mg/dL；n=2285）乳酸组。然后，通过倾向评分匹配法将高乳酸组与低乳酸组 1:1 匹配。主要结局为全因死亡率、主要不良心脏事件（MACEs）、缺血性卒中、心肌梗死、心力衰竭住院和终末期肾病。
在倾向评分匹配后，高乳酸组的全因死亡率（风险比 [HR] 1.54，95%置信区间 [CI] 1.41-1.67）、MACEs（HR 1.53，95% CI 1.29-1.81）、缺血性卒中（HR 1.47，95% CI 1.19-1.81）、心肌梗死（HR 1.52，95% CI 1.17-1.99）和终末期肾病（HR 1.42，95% CI 1.16-1.72）的风险更高。根据基线肾功能分层的亚组分析显示，各组之间几乎相似。
我们发现高乳酸血症与脓毒症幸存者的长期死亡率和 MACEs 风险相关。医生可能会考虑对出现高乳酸血症的患者进行更积极和及时的脓毒症治疗，以改善长期预后。
