围手术期乳酸水平作为大面积烧伤早期切痂植皮患者预后指标的研究

Perioperative lactate levels as prognostic indicators in patients undergoing early excision and grafting for extensive burns.

作者信息

Li Xinyi, Dong Xiaodan, Luo Jianhua, Wang Lin, Cao Yang, Zhang Yan, Liang Bing

机构信息

Department of Anesthesiology, Guangzhou Red Cross Hospital of Jinan University, 396 Tongfu Middle Road, Guangzhou, 510220, China.

出版信息

BMC Surg. 2025 Aug 31;25(1):402. doi: 10.1186/s12893-025-03133-y.

DOI:10.1186/s12893-025-03133-y

PMID:40887618

Abstract

BACKGROUND

Elevated lactate levels are reliable biomarkers of tissue hypoperfusion and metabolic stress. However, their prognostic significance in extensive burn patients undergoing early excision and grafting (EEG) remains unclear. This study aimed to evaluate the prognostic value of perioperative lactate levels in predicting clinical deterioration following EEG in patients with extensive burns.

METHODS

In this retrospective cohort study, adult burn patients with ≥ 50% total burn surface area (TBSA) or ≥ 20% full-thickness burns treated between March 2021 and September 2023 were included. Patients were categorized into Deterioration and Non-Deterioration groups based on changes in Sequential Organ Failure Assessment (SOFA) scores. Statistical analyses included univariate and multivariate logistic regression, as well as receiver-operating characteristic (ROC) curve analysis.

RESULTS

Of 82 patients, 37.8% were classified into the Deterioration Group. Compared with the Non-Deterioration Group, these patients presented with a significantly higher burn index (BI), larger surgical area, and greater intraoperative blood transfusion volumes. Temporal trends in lactate levels appeared to differ between groups: lactate levels peaked on POD1 and returned to baseline by postoperative Day 3(POD3) in the Non-Deterioration Group, whereas they remained persistently elevated in the Deterioration Group. Among all perioperative time points, lactate levels on POD3 were significantly higher in the Deterioration Group (2.88 ± 0.65 mmol/L vs. 2.27 ± 0.68 mmol/L, p < 0.001) and were independently associated with clinical deterioration clinical deterioration (OR 2.97, 95% CI 1.18-8.71, p = 0.031). POD3 lactate levels demonstrated the highest discriminatory performance for identifying postoperative deterioration (AUC = 0.761, 95% CI 0.656-0.866).

CONCLUSIONS

Among perioperative lactate levels in patients undergoing EEG for extensive burns, POD3 lactate levels were significantly associated with clinical deterioration and may serve as a useful marker to guide early risk assessment and supportive interventions.

摘要

背景

乳酸水平升高是组织灌注不足和代谢应激的可靠生物标志物。然而，其在接受早期切痂植皮术（EEG）的大面积烧伤患者中的预后意义仍不明确。本研究旨在评估围手术期乳酸水平对预测大面积烧伤患者EEG术后临床恶化的预后价值。

方法

在这项回顾性队列研究中，纳入了2021年3月至2023年9月期间治疗的成年烧伤患者，其烧伤总面积（TBSA）≥50%或全层烧伤面积≥20%。根据序贯器官衰竭评估（SOFA）评分的变化将患者分为恶化组和非恶化组。统计分析包括单因素和多因素逻辑回归以及受试者工作特征（ROC）曲线分析。

结果

82例患者中，37.8%被归类为恶化组。与非恶化组相比，这些患者的烧伤指数（BI）显著更高，手术面积更大，术中输血量更多。乳酸水平的时间趋势在两组之间似乎有所不同：非恶化组乳酸水平在术后第1天（POD1）达到峰值，并在术后第3天（POD3）恢复到基线水平，而恶化组乳酸水平持续升高。在所有围手术期时间点中，恶化组POD3时的乳酸水平显著更高（2.88±0.65 mmol/L对2.27±0.68 mmol/L，p<0.001），并且与临床恶化独立相关（OR 2.97，95%CI 1.18-8.71，p=0.031）。POD3时的乳酸水平在识别术后恶化方面表现出最高的判别性能（AUC=0.761，95%CI 0.656-0.866）。