Klemm Gregor, Markart Sebastian, Hermann Alexander, Staudinger Thomas, Hengstenberg Christian, Heinz Gottfried, Zilberszac Robert
Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria.
Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria.
J Clin Med. 2024 Mar 27;13(7):1932. doi: 10.3390/jcm13071932.
This study sought to evaluate the efficacy of various lactate measurements within the first 24 h post-intensive care unit (ICU) admission for predicting 30-day mortality in cardiogenic shock patients. It compared initial lactate levels, 24 h levels, peak levels, and 24 h clearance, alongside the Simplified Acute Physiology Score 3 (SAPS3) score, to enhance early treatment decision-making. A retrospective analysis of 64 patients assessed the prognostic performance of lactate levels and SAPS3 scores using logistic regression and AUROC calculations. Of the baseline parameters, only the SAPS3 score predicted survival independently. The lactate level after 24 h (LL) was the most accurate predictor of mortality, outperforming initial levels, peak levels, and 24 h-clearance, and showing a significant AUROC. LL greater than 3.1 mmol/L accurately predicted mortality with high specificity and moderate sensitivity. Among lactate measurements for predicting 30-day mortality in cardiogenic shock, the 24 h lactate level was the most effective one, suggesting its superiority for early prognostication over initial or peak levels and lactate clearance.
本研究旨在评估重症监护病房（ICU）入院后24小时内各种乳酸测量值对预测心源性休克患者30天死亡率的有效性。该研究比较了初始乳酸水平、24小时乳酸水平、峰值水平和24小时清除率，以及简化急性生理学评分3（SAPS3），以加强早期治疗决策。一项对64例患者的回顾性分析使用逻辑回归和受试者工作特征曲线下面积（AUROC）计算评估了乳酸水平和SAPS3评分的预后性能。在基线参数中，只有SAPS3评分能独立预测生存情况。24小时后的乳酸水平（LL）是最准确的死亡率预测指标，优于初始水平、峰值水平和24小时清除率，并显示出显著的AUROC。LL大于3.1 mmol/L能以高特异性和中等敏感性准确预测死亡率。在预测心源性休克患者30天死亡率的乳酸测量指标中，24小时乳酸水平是最有效的，表明其在早期预后评估方面优于初始或峰值水平以及乳酸清除率。
