Kim Dong Jung, Kim Hyun Joo, Chang Hyoung Woo
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon-si, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Sci Prog. 2025 Jan-Mar;108(1):368504241311966. doi: 10.1177/00368504241311966.
The physician order for life-sustaining treatment has been implemented in clinical practice for several years. However, the determination that a patient is in the terminal phase of life, a prerequisite for the withdrawal of life-sustaining treatment, lacks objective criteria. This study aimed to evaluate whether hyperlactatemia could serve as a reliable objective indicator for determining the terminal phase.
In this retrospective cohort study, we included 73,927 patients admitted to our institution from 2018 to 2023 who had at least one blood lactate measurement. We collected data on the highest blood lactate level measured during hospitalization, mortality, medical department, and intensive care unit (ICU) details. The primary endpoint was 30-day mortality, and we analyzed how well the highest lactate level during hospitalization predicted 30-day mortality across different age groups, medical departments, and ICUs.
Among the patients, 5493 died within 30 days of the maximum lactate measurement. The area under the receiver operating characteristic curve (AUROC) for predicting 30-day mortality based on the maximum lactate level was 0.870 (95% confidence interval [CI] 0.865-0.875) in all patients, indicating high accuracy. Setting the cutoff for the maximum lactate level at 20 mmol/L resulted in a precision of 87% and specificity of 99.8%. Subgroup analyses by age, medical department, and ICU yielded consistent results.
Severe hyperlactatemia during hospitalization showed high precision and specificity for predicting 30-day mortality across various patient groups. These findings suggest that hyperlactatemia could serve as an objective auxiliary indicator for determining the terminal phase, potentially improving consistency in end-of-life decision-making in clinical practice.
医生下达的维持生命治疗医嘱已在临床实践中实施数年。然而，确定患者处于生命终末期（这是停止维持生命治疗的前提条件）缺乏客观标准。本研究旨在评估高乳酸血症是否可作为确定生命终末期的可靠客观指标。
在这项回顾性队列研究中，我们纳入了2018年至2023年期间入住我院且至少进行过一次血乳酸测量的73927例患者。我们收集了住院期间测得的最高血乳酸水平、死亡率、医疗科室以及重症监护病房（ICU）的详细信息。主要终点是30天死亡率，我们分析了住院期间最高乳酸水平对不同年龄组、医疗科室和ICU的30天死亡率的预测效果。
在这些患者中，5493例在乳酸测量最大值后的30天内死亡。基于最高乳酸水平预测30天死亡率的受试者工作特征曲线下面积（AUROC）在所有患者中为0.870（95%置信区间[CI]0.865 - 0.875），表明准确性较高。将最高乳酸水平的临界值设定为20 mmol/L时，精确度为87%，特异性为99.8%。按年龄、医疗科室和ICU进行的亚组分析得出了一致的结果。
住院期间的严重高乳酸血症对预测各类患者群体的30天死亡率显示出较高的精确度和特异性。这些发现表明，高乳酸血症可作为确定生命终末期的客观辅助指标，可能会提高临床实践中临终决策的一致性。
