Arra Manoj, Mozelewski-Hill Sasha, Kaser Taylor, Ancona Rachel, Asaro Philip, Holthaus Christopher
Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
J Emerg Med. 2025 Aug;75:79-88. doi: 10.1016/j.jemermed.2025.05.023. Epub 2025 Jun 6.
Sepsis is a high morbidity and mortality disease that is highly prevalent in emergency departments (EDs). Lactate is often utilized as a biomarker for sepsis, though its performance among subgroups such as obese patients is not well characterized. Given existing data on differences in lactate metabolism at baseline between obese and nonobese patients, this may be clinically relevant in sepsis identification and prognostication.
We sought to compare differences in initial lactate measurements and lactate utility in predicting 30-day mortality between obese and nonobese body mass index (BMI) patients with vasopressor-dependent and non-vasopressor-dependent sepsis.
We performed a retrospective cohort study of obese and nonobese patients presenting to an adult hospital ED with sepsis with organ dysfunction. Patients were separated into vasopressor-dependent or non-vasopressor-dependent groups. The primary outcomes were differences in initial lactate and utility of initial lactate in predicting 30-day all-cause mortality by employing receiver operator characteristic curves.
Obese patients had lower initial lactate (2.2 mmol/L) compared with nonobese patients (2.4 mmol/L) in the non-vasopressor-dependent cohort. Lactate performed poorly-to-moderately well as a biomarker for 30-day mortality between obese and nonobese patients with sepsis, with no differences between BMI groups.
Initial lactate levels are lower in obese patients compared with nonobese patients, but are unlikely to be clinically significant. We found no difference in lactate's utility as a biomarker for prediction of 30-day all-cause mortality between obese and nonobese patients. Lactate overall maintains some utility as a predictor of sepsis mortality, though factors that contribute to lactate levels remain unclear.
脓毒症是一种发病率和死亡率都很高的疾病，在急诊科（ED）中非常普遍。乳酸常被用作脓毒症的生物标志物，但其在肥胖患者等亚组中的表现尚未得到充分描述。鉴于现有数据显示肥胖和非肥胖患者在基线时乳酸代谢存在差异，这在脓毒症的识别和预后评估中可能具有临床意义。
我们试图比较肥胖和非肥胖体重指数（BMI）患者在使用血管加压药和未使用血管加压药的脓毒症中，初始乳酸测量值的差异以及乳酸在预测30天死亡率方面的效用。
我们对一家成人医院急诊科收治的伴有器官功能障碍的脓毒症肥胖和非肥胖患者进行了一项回顾性队列研究。患者被分为使用血管加压药组或未使用血管加压药组。主要结局是通过采用受试者操作特征曲线，比较初始乳酸的差异以及初始乳酸在预测30天全因死亡率方面的效用。
在未使用血管加压药的队列中，肥胖患者的初始乳酸水平（2.2 mmol/L）低于非肥胖患者（2.4 mmol/L）。在肥胖和非肥胖脓毒症患者中，乳酸作为30天死亡率的生物标志物表现较差至中等，BMI组之间无差异。
与非肥胖患者相比，肥胖患者的初始乳酸水平较低，但可能不具有临床意义。我们发现肥胖和非肥胖患者在乳酸作为预测30天全因死亡率的生物标志物的效用方面没有差异。尽管导致乳酸水平的因素尚不清楚，但乳酸总体上仍保持着作为脓毒症死亡率预测指标的一定效用。
