Trebuian Cosmin Iosif, Marza Adina Maria, Chioibaş Raul, Şutoi Dumitru, Petrica Alina, Crintea-Najette Iulia, Popa Daian, Borcan Florin, Flondor Daniela, Mederle Ovidiu Alexandru
Department of Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania.
Department of Anesthesia and Intensive Care, Emergency County Hospital Resita, 320210 Resita, Romania.
Clin Pract. 2024 May 27;14(3):980-994. doi: 10.3390/clinpract14030078.
Lactate is a useful prognostic marker, as its level increases in hypoxic tissue and/or during accelerated aerobic glycolysis due to excessive beta-adrenergic stimulation and decreased lactate clearance. The Surviving Sepsis Campaign Bundle 2018 Update suggests premeasurement of lactate within 2-4 h so that physicians perform, assist, administer, and introduce lactate-guided resuscitation to reduce mortality due to sepsis.
A total of 108 patients with septic shock who underwent continuous renal replacement therapy (CRRT) for acute kidney injury were enrolled in this observational study. Demographic, clinical, and laboratory data were collected, and patients were divided into two groups: survivors and non-survivors.
Multivariate analysis demonstrated that lactate levels at 24 h after initiation of CRRT treatment, but not lactate levels at intensive care unit (ICU) admission, were associated with mortality. Lactate clearance was associated with lower mortality among the survivors (OR = 0.140) at 6 h after ICU admission and late mortality (OR = 0.260) after 24 h. The area under the ROC curves for mortality was 0.682 for initial lactate; 0.797 for lactate at 24 h; and 0.816 for lactate clearance at 24 h.
Our result reinforces that the determination of lactate dynamics represents a good predictor for mortality, and serial lactate measurements may be more useful prognostic markers than initial lactate in patients with septic shock.
乳酸是一种有用的预后标志物，因为在缺氧组织中以及由于过度的β-肾上腺素能刺激导致有氧糖酵解加速和乳酸清除减少时，其水平会升高。《2018年拯救脓毒症运动集束更新》建议在2 - 4小时内预先测定乳酸水平，以便医生进行、协助、实施并引入乳酸导向的复苏措施，以降低脓毒症导致的死亡率。
本观察性研究纳入了108例因急性肾损伤接受连续性肾脏替代治疗（CRRT）的感染性休克患者。收集了人口统计学、临床和实验室数据，并将患者分为两组：存活者和非存活者。
多变量分析表明，CRRT治疗开始后24小时的乳酸水平与死亡率相关，而重症监护病房（ICU）入院时的乳酸水平则无关。ICU入院后6小时的乳酸清除率与存活者较低的死亡率相关（OR = 0.140），24小时后的晚期死亡率也相关（OR = 0.260）。死亡率的ROC曲线下面积，初始乳酸为0.682；24小时乳酸为0.797；24小时乳酸清除率为0.816。
我们的结果强化了乳酸动力学测定是死亡率的良好预测指标这一观点，并且对于感染性休克患者，连续测定乳酸可能比初始乳酸是更有用的预后标志物。
