急诊科就诊时测定的乳酸水平与老年患者住院死亡率及入住重症监护病房概率之间的关联。

Association between lactate determined at emergency department arrival and the probability of inhospital mortality and intensive care admission in elderly patients.

作者信息

Alquézar-Arbé Aitor, Pérez-Baena Sergio, Fernández Cesáreo, Aguiló Sira, Burillo Guillermo, Jacob Javier, Llorens Pere, Santianes Patiño Jesús, Queizán García Paula, Rosendo Mesino Diana, Troiano Ungerer Osvaldo Jorge, Vaswani-Bulchand Aarati, Rodríguez-Cabrera Montserrat, Suárez Pineda Mabel Coromoto, Gantes Nieto Patricia, Alemany González Francesc Xavier, Puche Alcaraz Ana, Bóveda García María, Veguillas Benito Mónica, Chamorro Francisco, Suero Méndez Coral, Fragero Blesa Eva, Gil Hernández Rodrigo Javier, Pedraza Ramírez Paula, González Del Castillo Juan, Miró Òscar

机构信息

Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona.

Emergency Department, Hospital Clínico San Carlos, IDISSC, Complutense University, Madrid.

出版信息

Eur J Emerg Med. 2025 Jun 1;32(3):171-179. doi: 10.1097/MEJ.0000000000001207. Epub 2024 Dec 11.

DOI:10.1097/MEJ.0000000000001207

PMID:39693496

Abstract

BACKGROUND AND IMPORTANCE

Elderly patients often have atypical clinical presentations. Lactate measurement on arrival at the Emergency Department (ED) could be useful to identify elderly patients with a bad prognosis.

OBJECTIVE

The study aimed to investigate the relationship between serum lactate determined at ED arrival and the probability of inhospital mortality and intensive care (ICU) admission in elderly patients.

DESIGN

Retrospective multipurpose registry. Secondary analysis of the EDEN cohort (Elderly Department and Elder Needs).

SETTINGS AND PARTICIPANTS

All patients ≥65 years attending 52 Spanish EDs during 2 week and in whom serum lactate was determined at ED arrival.

OUTCOME MEASURES AND ANALYSIS

The relationship between serum lactate values and the risk of inhospital all-cause death and transfer from the ED to the ICU was assessed by unadjusted and adjusted logistic regression assuming linearity and restricted cubic spline models assuming nonlinearity.

RESULTS

The cohort included 25 557 patients. The 3024 patients in whom lactate was measured were analyzed. The median age was 81 years (74-87), 1506 (27.2%) were women, 591 (19.5%) had serious comorbidities, 475 (15.7%) severe dependency, and 648 (21.4%) dementia. Death occurred during hospitalization in 217 patients (7.2%) and 53 patients (1.75%) were admitted to the ICU. Serum lactate values were nonlinear related to inhospital mortality and ICU admission. Serum lactate >3.1 mmol/L [odds ratio (OR): 1.60, 95% confidence interval (CI): 1.02-2.50] for inhospital mortality and 3.2 mmol/L (OR: 2.83, 95% CI: 1.03-6.79) for ICU admission were associated with significantly increased ORs in the adjusted models.

CONCLUSION

Serum lactate measured at ED arrival has a significant and exponential relationship with inhospital mortality and ICU admission in elderly patients.

摘要

背景与重要性

老年患者常常有非典型的临床表现。在急诊科（ED）就诊时测定乳酸水平可能有助于识别预后不良的老年患者。

目的

本研究旨在探讨急诊就诊时测定的血清乳酸水平与老年患者住院死亡率及入住重症监护病房（ICU）概率之间的关系。

设计

回顾性多用途登记研究。对EDEN队列（老年科与老年需求）进行二次分析。

地点与参与者

在2周内前往52家西班牙急诊科就诊且年龄≥65岁、在急诊就诊时测定了血清乳酸水平的所有患者。

观察指标与分析

采用未校正及校正逻辑回归（假设为线性关系）以及受限立方样条模型（假设为非线性关系）评估血清乳酸水平与住院全因死亡风险及从急诊科转入ICU之间的关系。

结果

该队列包括25557例患者。对其中测定了乳酸水平的3024例患者进行了分析。中位年龄为81岁（74 - 87岁），1506例（27.2%）为女性，591例（19.5%）患有严重合并症，475例（15.7%）有严重依赖，648例（21.4%）患有痴呆。217例患者（7.2%）在住院期间死亡，53例患者（1.75%）入住ICU。血清乳酸水平与住院死亡率及入住ICU呈非线性相关。校正模型中，血清乳酸>3.1 mmol/L（比值比[OR]：1.60，95%置信区间[CI]：1.02 - 2.50）与住院死亡率相关，血清乳酸>3.2 mmol/L（OR：2.83，95% CI：1.03 - 6.79）与入住ICU相关，且OR值显著升高。