Joseph Philip A, Doluweera Dinul, Chandraratne Amalka, Balasubramaniam Branavan, Abeyratne Varuna, Hewa Saman P, Rambukwella Roshan, Wanigasuriya Kamani P, Indrakumar Jegarajah, Perera Nilanka
University Medical Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka.
Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
BMC Infect Dis. 2025 Mar 31;25(1):438. doi: 10.1186/s12879-025-10810-z.
Venous lactate (VL) measured by a blood‒gas analyser is not widely available despite its importance in the management of sepsis. Capillary lactate (CL) measured via a hand-held lactate analyser is a feasible and less expensive option. The aim of this study was to determine the correlation between CL and VL in sepsis patients at 0 h (t) and 6 h (t) and identify the best CL and lactate clearance cut-off values that predicts a poor outcome.
A descriptive study was conducted recruiting all patients with suspected sepsis (qSOFA ≥ 2 with evidence of infection) admitted to a tertiary care hospital in Sri Lanka between March and June 2022. "Lactate-plus", a hand-held lactate analyser, was used to measure CL and VL at t and t of admission. The lactate analyser was tested for accuracy and calibrated in a pilot study of 30 patients by correlating to laboratory lactate values. Patient demographics, clinical data and outcomes during hospitalization and at 28 days were assessed.
There were 102 patients with suspected sepsis and a median age of 71.5 (interquartile range: 62-77) years were recruited. Majority were females (n = 52, 51%). Majority of the source of infection was pulmonary (n = 57, 55.9%) and urological (n = 19, 18.6%). Paired CL and VL values significantly correlated at both t and t (p < 0.001). CL at t predicted 28-day mortality with a ROC curve AUC of 0.89 (95% CI: 0.82-0.95, p < 0.05) and 3.5 mmol/L was the best cut-off value with an 85% sensitivity and 78% specificity. CL ≥ 3.5 at t was associated with increased intensive care unit (ICU) admission (p < 0.01), vasopressor requirement (p < 0.0001), and a higher mortality rate (p < 0.001) compared to CL < 3.5. Additionally, a capillary lactate clearance greater than 64% predicted a good outcome, with a 97% sensitivity and 91% specificity.
CL measured by a lactate meter correlates well with VL and effectively predicts sepsis outcomes. A CL cut-off ≥ 3.5 mmol/L at admission increases the risk of mortality, vasopressor requirement and ICU admission, making CL a useful tool for risk assessment in sepsis.
尽管静脉血乳酸（VL）在脓毒症管理中具有重要意义，但通过血气分析仪测量的静脉血乳酸并不普遍可用。通过手持式乳酸分析仪测量的毛细血管血乳酸（CL）是一种可行且成本较低的选择。本研究的目的是确定脓毒症患者在0小时（t）和6小时（t）时CL与VL之间的相关性，并确定预测不良结局的最佳CL和乳酸清除率临界值。
进行了一项描述性研究，纳入了2022年3月至6月期间入住斯里兰卡一家三级护理医院的所有疑似脓毒症患者（qSOFA≥2且有感染证据）。使用手持式乳酸分析仪“Lactate-plus”在入院时的t和t测量CL和VL。在一项对30名患者的预试验中，通过与实验室乳酸值进行相关性分析，对乳酸分析仪进行了准确性测试和校准。评估了患者的人口统计学特征、临床数据以及住院期间和28天时的结局。
共纳入102例疑似脓毒症患者，中位年龄为71.5岁（四分位间距：62-77岁）。大多数为女性（n = 52，51%）。感染源主要为肺部（n = 57，55.9%）和泌尿系统（n = 19，18.6%）。配对的CL和VL值在t和t时均显著相关（p < 0.001）。入院时t的CL预测28天死亡率的ROC曲线AUC为0.89（95%CI：0.82-0.95，p < 0.05），最佳临界值为3.5 mmol/L，敏感性为85%，特异性为78%。与CL < 3.5相比，入院时t的CL≥3.5与重症监护病房（ICU）入住率增加（p < 0.01）、血管活性药物需求增加（p < 0.0001）和死亡率升高（p < 0.001）相关。此外，毛细血管血乳酸清除率大于64%预测结局良好，敏感性为97%，特异性为91%。
通过乳酸计测量的CL与VL相关性良好，可有效预测脓毒症结局。入院时CL临界值≥3.5 mmol/L会增加死亡风险、血管活性药物需求和ICU入住率，使CL成为脓毒症风险评估的有用工具。
