Kumrawat Abhijeet, Gupta Sunita, Dhillon Harmanjeet S, Kumrawat Purva
General Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, IND.
Anaesthesia, Uttar Pradesh University of Medical Sciences, Saifai, IND.
Cureus. 2024 Oct 13;16(10):e71372. doi: 10.7759/cureus.71372. eCollection 2024 Oct.
Introduction Critical illness refers to life-threatening conditions requiring mechanical or pharmacological intervention to maintain organ function. Prognostic models, such as the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, have been widely used to predict mortality in intensive care unit (ICU) patients. Lactate levels are emerging as a valuable biomarker in this context. This study aims to determine the prognostic value of lactate levels upon admission in critically ill patients and to assess their correlation with SOFA and APACHE II scores. Methods This descriptive cross-sectional study included 200 critically ill patients admitted to the emergency department over one year. Data on patient demographics, clinical findings, and laboratory results were collected, and lactate levels and SOFA and APACHE II scores were measured at the time of admission. Patients were followed throughout their hospital stay, with outcomes classified as survival or mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of lactate, SOFA, and APACHE II scores. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States). Results The mean age of the patients was 56.8±16.9 years; 110 (55%) were men, and 90 (45%) were women. In total, 79 patients (39.5%) were non-survivors, and 121 (60.5%) were survivors. Lactate levels were significantly higher in non-survivors (3.56±1.90 mmol/L) compared to survivors (1.47±0.82 mmol/L) (p<0.001). The SOFA and APACHE II scores were also significantly higher in non-survivors (SOFA: 6.35±3.19; APACHE II: 19.91±8.21) than in survivors (SOFA: 3.14±2.02; APACHE II: 12.45±5.76) (p<0.001). The ROC curve analysis showed that lactate had an area under the curve (AUC) of 0.909, SOFA had an AUC of 0.809, and APACHE II had an AUC of 0.769 for predicting mortality. Conclusions Lactate levels are a highly sensitive predictor of mortality in critically ill patients, with significant correlations to SOFA and APACHE II scores. Lactate, as a single rapid test, provides substantial prognostic information and can aid in early triage and clinical decision-making, particularly in resource-limited settings. A single arterial lactate measurement at admission is an effective tool for predicting patient outcomes in the ICU.
引言 危重病是指需要机械或药物干预以维持器官功能的危及生命的状况。序贯器官衰竭评估（SOFA）和急性生理与慢性健康状况评估（APACHE）II评分等预后模型已被广泛用于预测重症监护病房（ICU）患者的死亡率。在此背景下，乳酸水平正成为一种有价值的生物标志物。本研究旨在确定危重病患者入院时乳酸水平的预后价值，并评估其与SOFA和APACHE II评分的相关性。
方法 本描述性横断面研究纳入了一年内入住急诊科的200例危重病患者。收集了患者的人口统计学数据、临床检查结果和实验室检查结果，并在入院时测量了乳酸水平以及SOFA和APACHE II评分。在患者住院期间对其进行随访，结局分为存活或死亡。采用受试者操作特征（ROC）曲线分析来评估乳酸、SOFA和APACHE II评分的预测价值。使用IBM SPSS Statistics for Windows 27.0版（2020年发布；IBM公司，美国纽约州阿蒙克）进行统计分析。
结果 患者的平均年龄为56.8±16.9岁；男性110例（55%），女性90例（45%）。共有79例患者（39.5%）死亡，121例（60.5%）存活。与存活患者（1.47±0.82 mmol/L）相比，死亡患者的乳酸水平显著更高（3.56±1.90 mmol/L）（p<0.001）。死亡患者的SOFA和APACHE II评分也显著高于存活患者（SOFA：6.35±3.19；APACHE II：19.91±8.21）（SOFA：3.14±2.02；APACHE II：12.45±5.76）（p<0.001）。ROC曲线分析显示，乳酸预测死亡率的曲线下面积（AUC）为0.909，SOFA为0.809，APACHE II为0.769。
结论 乳酸水平是危重病患者死亡率的高度敏感预测指标，与SOFA和APACHE II评分显著相关。乳酸作为一项单一的快速检测，可提供大量预后信息，并有助于早期分诊和临床决策，特别是在资源有限的环境中。入院时单次动脉血乳酸测量是预测ICU患者结局的有效工具。
