Emamian Nikki, Miller Taylor, Glick Zoe, Day Lauren, Becker Lauren, Singh Aditi, Shi Tesia, Rea Jeffrey, Boswell Kimberly, Tran Quincy K
Emergency Medicine and Critical Care Department of Emergency Medicine University of Maryland School of Medicine Baltimore Maryland USA.
Department of Emergency Medicine University of Maryland School of Medicine Baltimore Maryland USA.
J Am Coll Emerg Physicians Open. 2024 Aug 25;5(5):e13281. doi: 10.1002/emp2.13281. eCollection 2024 Oct.
We hypothesized that lactate clearance and reduction of the Sequential Organ Failure Assessment (SOFA) score during patients' critical care resuscitation unit (CCRU) stay would be associated with lower in-hospital mortality.
This was a retrospective study of adult patients who had sepsis diagnoses and were admitted to the CCRU in 2018. Multivariable logistic regression analysis was performed to assess the association of clinical factors, lactate clearance, and SOFA reduction with hospital mortality.
A total of 401 patients with lactate clearance data and 455 patients with SOFA score data were included in the study. The mean (SD) lactate and SOFA score on admission were 2.2 (1.8) mmol/L and 4.4 (4.3), respectively. Average lactate clearance was 0.1 (2.6) mmol/L, and average SOFA score reduction was 0.65 (5.9). Patients with a one point reduction in SOFA score during their CCRU stay had a 31% reduction of mortality (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.62-0.77, < 0.001). SOFA score reduction was associated with lower hospital mortality for both surgical patients (OR 0.69, 95% CI 0.58-0.81, < 0.001) and non-surgical patients (OR 0.71 95% CI 0.06-0.83, < 0.001).
SOFA score reduction, but not lactate clearance during the CCRU stay, was associated with lower odds of in-hospital mortality. These findings suggest that resuscitative efforts leading to an early improvement in SOFA score may benefit patients with sepsis.
我们假设，在患者入住重症监护复苏病房（CCRU）期间，乳酸清除率及序贯器官衰竭评估（SOFA）评分的降低与较低的院内死亡率相关。
这是一项针对2018年被诊断为脓毒症并入住CCRU的成年患者的回顾性研究。采用多变量逻辑回归分析来评估临床因素、乳酸清除率及SOFA评分降低与医院死亡率之间的关联。
共有401例有乳酸清除率数据的患者和455例有SOFA评分数据的患者纳入研究。入院时乳酸的平均（标准差）值和SOFA评分分别为2.2（1.8）mmol/L和4.4（4.3）。平均乳酸清除率为0.1（2.6）mmol/L，平均SOFA评分降低0.65（5.9）。在CCRU住院期间SOFA评分降低1分的患者死亡率降低31%（比值比[OR]0.69，95%置信区间[CI]0.62 - 0.77，<0.001）。对于外科患者（OR 0.69，95% CI 0.58 - 0.81，<0.001）和非外科患者（OR 0.71，95% CI 0.06 - 0.83，<0.001），SOFA评分降低均与较低的医院死亡率相关。
在CCRU住院期间，与较低的院内死亡几率相关的是SOFA评分降低，而非乳酸清除率。这些发现表明，使SOFA评分早期改善的复苏措施可能对脓毒症患者有益。
