Qian Xiangfeng, Sheng Yi, Jiang Yinsheng, Xu Yong'an
Department of Emergency Medicine, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Emergency Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Front Neurol. 2024 Jul 1;15:1371827. doi: 10.3389/fneur.2024.1371827. eCollection 2024.
This study aimed to investigate the associations of serum lactate level [within and after 24 h of the intensive care unit (ICU) admission] and lactate clearance rate with delirium and assess associations of lactate and lactate clearance rate with 30-day mortality in delirium patients.
Data in this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database in 2012-2019. The associations of lactate and lactate clearance rate with delirium were explored through univariable and multivariable logistic regression analyses, whereas the associations of lactate and lactate clearance rate with 30-day mortality in delirium patients were investigated using univariable and multivariable Cox regression analyses. Subgroup analysis was performed for age, gender, sepsis, hypertension, sedative drug, ventilation, antibiotic drug, vasopressors, and the Sequential Organ Failure Assessment (SOFA) score. The evaluation indexes were odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs).
Among 7,812 (14.58%) eligible participants, 4,338 (8.19%) had delirium and 1,903 (24.36%) died within 30 days. After adjusting for covariates, patients with lactic acidosis (lactate level > 5 mmol/L and PH < 7.35) at T0 (within 24 h of the ICU admission) had higher odds of delirium (OR = 1.235, 95%CI: 1.105-1.382). Hyperlactatemia (lactate level 2-5 mmol/L and PH > 7.35) at T1 (after 24 h of the ICU admission) was also associated with higher odds of delirium (OR = 1.277, 95%CI: 1.126-1.447). Lactate clearance rate > 50% was linked to lower odds of delirium (OR = 0.705, 95%CI: 0.613-0.811), and this relationship was also observed in ≥65 years old, female, male, non-sepsis, sepsis, non-hypertension, non-sedative drug use, sedative drug use, ventilation, antibiotic drug use, use of vasopressors, and different SOFA score subgroups (all < 0.05). Additionally, hyperlactatemia and lactic acidosis (whether at T0 or T1) may be potential risk factors for 30-day mortality in delirium patients, whereas lactate clearance rate ≥ 0 had a potential protective effect on 30-day mortality (all < 0.05).
Higher serum lactate levels in the early stage of the ICU were associated with a higher risk of delirium and subsequent mortality. Measures taken to increase the lactate clearance rate are necessary to reduce potential delirium or mortality risk in clinical settings. However, more evidence from prospective studies is needed to verify these findings.
本研究旨在探讨血清乳酸水平[重症监护病房（ICU）入院后24小时内及之后]和乳酸清除率与谵妄的相关性，并评估乳酸和乳酸清除率与谵妄患者30天死亡率的相关性。
本回顾性队列研究的数据来自2012 - 2019年的重症监护医学信息集市IV（MIMIC-IV）数据库。通过单变量和多变量逻辑回归分析探讨乳酸和乳酸清除率与谵妄的相关性，而使用单变量和多变量Cox回归分析研究乳酸和乳酸清除率与谵妄患者30天死亡率的相关性。对年龄、性别、脓毒症、高血压、镇静药物、通气、抗生素药物、血管升压药和序贯器官衰竭评估（SOFA）评分进行亚组分析。评估指标为比值比（OR）、风险比（HR）和95%置信区间（CI）。
在7812名（14.58%）符合条件的参与者中，4338名（8.19%）发生谵妄，1903名（24.36%）在30天内死亡。调整协变量后，T0（ICU入院后24小时内）发生乳酸性酸中毒（乳酸水平>5 mmol/L且PH<7.35）的患者发生谵妄的几率更高（OR = 1.235，95%CI：1.105 - 1.382）。T1（ICU入院24小时后）高乳酸血症（乳酸水平2 - 5 mmol/L且PH>7.35）也与谵妄几率较高相关（OR = 1.277，95%CI：1.126 - 1.447）。乳酸清除率>50%与谵妄几率较低相关（OR = 0.705，95%CI：0.613 - 0.811），并且在≥65岁、女性、男性、非脓毒症、脓毒症、非高血压、未使用镇静药物、使用镇静药物、通气、使用抗生素药物、使用血管升压药以及不同SOFA评分亚组中均观察到这种关系（均P<0.05）。此外，高乳酸血症和乳酸性酸中毒（无论在T0还是T1）可能是谵妄患者30天死亡率的潜在危险因素，而乳酸清除率≥0对30天死亡率有潜在保护作用（均P<0.05）。
ICU早期较高的血清乳酸水平与谵妄及随后的死亡风险较高相关。采取措施提高乳酸清除率对于降低临床环境中潜在的谵妄或死亡风险是必要的。然而，需要更多前瞻性研究的证据来验证这些发现。
