Kumar Aashish, Anstey Christopher, Doola Ra'eesa, Mcllroy Philippa, Whebell Stephen, Shekar Kiran, Attokaran Antony, Marella Prashanti, White Kyle, Luke Stephen, Tabah Alexis, Laupland Kevin, Ramanan Mahesh
Intensive Care Unit, Logan Hospital, Brisbane, QLD 4131, Australia.
School of Medicine and Dentistry, Griffith University, Sunshine Coast, QLD 4575, Australia.
J Clin Med. 2024 Aug 21;13(16):4933. doi: 10.3390/jcm13164933.
: This study aimed to determine the associations between lactate clearance in hyperlactataemic patients with diabetic ketoacidosis (DKA) and intensive care unit (ICU), hospital length of stay (LOS), and case-fatality. : A retrospective, multicentre, cohort study of adult patients admitted to ICU with hyperlactataemia and a primary diagnosis of DKA from twelve sites in Queensland, Australia was conducted utilising pre-existing datasets that were linked for research purposes. The patients were divided into early and late lactate clearance groups; the early lactate clearance group included patients whose lactate returned to <2.0 mmol/L within 12 h, and the remainder were classified as late lactate clearance group. : The final dataset included 511 patients, 427 in the early lactate clearance group and 84 in the late lactate clearance group. Late lactate clearance was associated with increasing ICU LOS (β = +15.82, 95% CI +0.05 to +31.59, < 0.049), increasing hospital LOS (β = +7.24, 95% CI +0.11 to 14.37, = 0.048) and increasing Acute Physiology and Chronic Health Evaluation(APACHE) III score (ICU LOS outcome variable β = +1.05, 95% CI +0.88 to +1.22, < 0.001; hospital LOS outcome variable β = +3.40, 95% CI +2.22 to 4.57, < 0.001). Hospital case-fatality was not significantly different (2.2% in the early clearance group vs. 1.7% in the late clearance group, = 0.496). : In hyperlactataemic patients with DKA, late lactate clearance was associated with a statistically significant increase in both ICU and hospital LOS, though the clinical significance in both is minor.
本研究旨在确定糖尿病酮症酸中毒（DKA）高乳酸血症患者的乳酸清除率与重症监护病房（ICU）、住院时间（LOS）及病死率之间的关联。对澳大利亚昆士兰州12个地点因高乳酸血症入住ICU且初步诊断为DKA的成年患者进行了一项回顾性、多中心队列研究，利用为研究目的而关联的现有数据集。患者被分为早期和晚期乳酸清除组；早期乳酸清除组包括乳酸在12小时内恢复至<2.0 mmol/L的患者，其余患者被归类为晚期乳酸清除组。最终数据集包括511例患者，早期乳酸清除组427例，晚期乳酸清除组84例。晚期乳酸清除与ICU住院时间增加相关（β = +15.82，95%可信区间+0.05至+31.59，P < 0.049），住院时间增加（β = +7.24，95%可信区间+0.11至14.37，P = 0.048）以及急性生理与慢性健康评估（APACHE）III评分增加（ICU住院时间结果变量β = +1.05，95%可信区间+0.88至+1.22，P < 0.001；住院时间结果变量β = +3.40，95%可信区间+2.22至4.57，P < 0.001）。医院病死率无显著差异（早期清除组为2.2%，晚期清除组为1.7%，P = 0.496）。在DKA高乳酸血症患者中，晚期乳酸清除与ICU和住院时间的统计学显著增加相关，尽管两者的临床意义较小。
