Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Medicine, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Merck KGaA (SQ-Animal Affairs), Frankfurterstrasse 250, 64293 Darmstadt, Germany.
Int J Mol Sci. 2024 Jun 9;25(12):6391. doi: 10.3390/ijms25126391.
Tissue hypoxia is associated with the development of organ dysfunction and death in critically ill patients commonly captured using blood lactate. The kinetic parameters of serial lactate evaluations are superior at predicting mortality compared with single values. S-adenosylhomocysteine (SAH), which is also associated with hypoxia, was recently established as a useful predictor of septic organ dysfunction and death. We evaluated the performance of kinetic SAH parameters for mortality prediction compared with lactate parameters in a cohort of critically ill patients. For lactate and SAH, maxima and means as well as the normalized area scores were calculated for two periods: the first 24 h and the total study period of up to five days following ICU admission. Their performance in predicting in-hospital mortality were compared in 99 patients. All evaluated parameters of lactate and SAH were significantly higher in non-survivors compared with survivors. In univariate analysis, the predictive power for mortality of SAH was higher compared with lactate in all forms of application. Multivariable models containing SAH parameters demonstrated higher predictive values for mortality than models based on lactate parameters. The optimal models for mortality prediction incorporated both lactate and SAH parameters. Compared with lactate, SAH displayed stronger predictive power for mortality in static and dynamic application in critically ill patients.
组织缺氧与危重病患者器官功能障碍和死亡的发展有关，通常使用血乳酸来捕捉。与单次测量值相比，连续乳酸评估的动力学参数在预测死亡率方面更具优势。S-腺苷同型半胱氨酸 (SAH) 也与缺氧有关，最近被确定为预测脓毒症器官功能障碍和死亡的有用指标。我们评估了动力学 SAH 参数与乳酸参数在危重病患者队列中预测死亡率的性能。对于乳酸和 SAH，计算了两个时间段的最大值和平均值以及归一化面积分数：第一个 24 小时和 ICU 入院后长达五天的总研究期间。在 99 名患者中比较了它们对住院死亡率的预测性能。与幸存者相比，非幸存者的乳酸和 SAH 的所有评估参数均显着升高。在单变量分析中，与乳酸相比，SAH 在所有应用形式中的死亡率预测能力更高。包含 SAH 参数的多变量模型显示出比基于乳酸参数的模型更高的死亡率预测值。包含乳酸和 SAH 参数的最佳模型用于死亡率预测。与乳酸相比，SAH 在危重病患者的静态和动态应用中对死亡率具有更强的预测能力。
