Zhu Binlu, Zhou Ruixi, Qin Jiangwei, Li Yifei
Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, China.
Biomedicines. 2024 Feb 17;12(2):447. doi: 10.3390/biomedicines12020447.
Blood lactate is a potentially useful biomarker to predict the mortality and severity of sepsis. The purpose of this study is to systematically review the ability of lactate to predict hierarchical sepsis clinical outcomes and distinguish sepsis, severe sepsis and septic shock. : We conducted an exhaustive search of the PubMed, Embase and Cochrane Library databases for studies published before 1 October 2022. Inclusion criteria mandated the presence of case-control, cohort studies and randomized controlled trials that established the association between before-treatment blood lactate levels and the mortality of individuals with sepsis, severe sepsis or septic shock. Data was analyzed using STATA Version 16.0. A total of 127 studies, encompassing 107,445 patients, were ultimately incorporated into our analysis. Meta-analysis of blood lactate levels at varying thresholds revealed a statistically significant elevation in blood lactate levels predicting mortality (OR = 1.57, 95% CI 1.48-1.65, I = 92.8%, < 0.00001). Blood lactate levels were significantly higher in non-survivors compared to survivors in sepsis patients (SMD = 0.77, 95% CI 0.74-0.79, I = 83.7%, = 0.000). The prognostic utility of blood lactate in sepsis mortality was validated through hierarchical summary receiver operating characteristic curve (HSROC) analysis, yielding an area under the curve (AUC) of 0.72 (95% CI 0.68-0.76), accompanied by a summary sensitivity of 0.65 (95% CI 0.59-0.7) and a summary specificity of 0.7 (95% CI 0.64-0.75). Unfortunately, the network meta-analysis could not identify any significant differences in average blood lactate values' assessments among sepsis, severe sepsis and septic shock patients. This meta-analysis demonstrated that high-level blood lactate was associated with a higher risk of sepsis mortality. Lactate has a relatively accurate predictive ability for the mortality risk of sepsis. However, the network analysis found that the levels of blood lactate were not effective in distinguishing between patients with sepsis, severe sepsis and septic shock.
血乳酸是预测脓毒症死亡率和严重程度的一种潜在有用的生物标志物。本研究的目的是系统评价乳酸预测脓毒症分级临床结局以及区分脓毒症、严重脓毒症和脓毒性休克的能力。我们对PubMed、Embase和Cochrane图书馆数据库进行了详尽检索，以查找2022年10月1日前发表的研究。纳入标准要求存在病例对照研究、队列研究和随机对照试验，这些研究确立了治疗前血乳酸水平与脓毒症、严重脓毒症或脓毒性休克患者死亡率之间的关联。使用STATA 16.0版本分析数据。共有127项研究（涉及107445例患者）最终纳入我们的分析。对不同阈值下的血乳酸水平进行荟萃分析显示，预测死亡率的血乳酸水平有统计学意义的升高（OR = 1.57，95% CI 1.48 - 1.65，I² = 92.8%，P < 0.00001）。脓毒症患者中，非幸存者的血乳酸水平显著高于幸存者（SMD = 0.77，95% CI 0.74 - 0.79，I² = 83.7%，P = 0.000）。通过分层汇总接受者操作特征曲线（HSROC）分析验证了血乳酸在脓毒症死亡率方面的预后效用，曲线下面积（AUC）为0.72（95% CI 0.68 - 0.76），汇总敏感度为0.65（95% CI 0.59 - 0.7），汇总特异度为0.7（95% CI 0.64 - 0.75）。遗憾的是，网状荟萃分析未能发现脓毒症、严重脓毒症和脓毒性休克患者在平均血乳酸值评估方面存在任何显著差异。这项荟萃分析表明，高血乳酸水平与脓毒症死亡率风险较高相关。乳酸对脓毒症死亡风险具有相对准确的预测能力。然而，网状分析发现血乳酸水平在区分脓毒症、严重脓毒症和脓毒性休克患者方面无效。
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