Department of Internal Medicine, Division of Critical Care, Gazi University Faculty of Medicine, Ankara, Turkey.
Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey.
Ann Hematol. 2024 Oct;103(10):4239-4245. doi: 10.1007/s00277-024-05977-5. Epub 2024 Sep 5.
The coexistence of sepsis and hematological malignancies increases patient vulnerability, revealing the need for precise prognostic markers. This study explores the prognostic significance of lactate levels and clearance in septic patients with hematological malignancies.
A retrospective cohort study from January 2016 to December 2019 in a tertiary hematological intensive care unit (ICU) included 167 adults with hematological malignancies and sepsis. The relationship between lactate levels, hyperlactatemia, lactate clearance, and ICU outcomes was investigated. ICU survivors and non-survivors were compared to identify the factors affecting ICU mortality.
Patients were primarily with lymphoma and acute leukemia (66%) and had frequent hyperlactatemia (64%) on ICU admission. ICU non-survivors demonstrated higher lactate levels and hyperlactatemia frequency at various time points (0, 6, and 12 h) than survivors. Lactate clearance and liver function tests did not differ significantly between the two groups. Invasive mechanical ventilation [OR (95% confidence interval-CI): 20.4 (2.4-79.8), p < 0.01], requirement of vasopressors [OR (95% CI): 5.6 (1.3-24.5), p < 0.01], lactate level at the 6th hour [OR (95% CI): 1.51 (1.1-2.07), p = 0.01], and APACHE II score (OR (95% CI): 1.16 (1.01-1.34), p = 0.05) were independent risk factors for ICU mortality. The Area Under the Curve for APACHE II score and lactate level at the 6th hour were 0.774 (95% CI: 0.682-0.866) and 0.703 (95% CI: 0.602-0.804), respectively.
While elevated lactate levels correlate with mortality rate and lactate level at the 6th hour is an independent risk factor for mortality, the absence of a significant difference in lactate clearance challenges traditional assumptions. These results question the commonly accepted perspective regarding lactate dynamics in sepsis among individuals with hematological malignancies.
İnci K, et al. "Hyperlactatemia, lactate clearance and outcome in critically ill patients with hematological malignancies," 22nd ınternational intensive care symposium, 2019.
脓毒症和血液恶性肿瘤的共存增加了患者的脆弱性，这凸显了对精确预后标志物的需求。本研究探讨了血液恶性肿瘤合并脓毒症患者中乳酸水平和清除率的预后意义。
这是一项回顾性队列研究，纳入了 2016 年 1 月至 2019 年 12 月在一家三级血液重症监护病房（ICU）的 167 名成人血液恶性肿瘤合并脓毒症患者。研究了乳酸水平、高乳酸血症、乳酸清除率与 ICU 结局之间的关系。比较了 ICU 幸存者和非幸存者，以确定影响 ICU 死亡率的因素。
患者主要患有淋巴瘤和急性白血病（66%），入 ICU 时普遍存在高乳酸血症（64%）。与幸存者相比，ICU 非幸存者在各个时间点（0、6 和 12 小时）的乳酸水平和高乳酸血症频率更高。两组间的乳酸清除率和肝功能检查无显著差异。有创机械通气[比值比（95%置信区间-CI）：20.4（2.4-79.8），p<0.01]、需要血管加压药[比值比（95%CI）：5.6（1.3-24.5），p<0.01]、第 6 小时的乳酸水平[比值比（95%CI）：1.51（1.1-2.07），p=0.01]和急性生理学与慢性健康状况评分系统 II 评分（比值比（95%CI）：1.16（1.01-1.34），p=0.05）是 ICU 死亡率的独立危险因素。急性生理学与慢性健康状况评分系统 II 评分和第 6 小时乳酸水平的曲线下面积分别为 0.774（95%CI：0.682-0.866）和 0.703（95%CI：0.602-0.804）。
虽然乳酸水平升高与死亡率相关，且第 6 小时的乳酸水平是死亡率的独立危险因素，但乳酸清除率无显著差异对传统观点提出了挑战。这些结果对血液恶性肿瘤合并脓毒症患者中乳酸动力学的普遍观点提出了质疑。
Inci K，等。“血液恶性肿瘤危重症患者的高乳酸血症、乳酸清除率与结局”，第 22 届国际重症监护研讨会，2019 年。
