何种乳酸指标更能有效预测高乳酸血症感染性休克患者14 d病死率

doi:10.3969/j.issn.1006-7795.2018.01.003

首都医科大学学报 ›› 2018, Vol. 39 ›› Issue (1): 9-13.doi: 10.3969/j.issn.1006-7795.2018.01.003

何种乳酸指标更能有效预测高乳酸血症感染性休克患者14 d病死率

李雯¹, 任珊^1,2, 姜利¹, 朱波¹, 姜琦¹, 席修明¹

1. 首都医科大学附属复兴医院危重症医学科, 北京 100069;
2. 河北省人民医院重症医学科, 石家庄 050051

收稿日期:2017-11-13 出版日期:2018-01-21 发布日期:2018-01-27
通讯作者: 席修明 E-mail:xxm2937@163.com
基金资助:
国家科技支撑计划（2012BAI11B05）。

Prediction of 14 day mortality in patients with hyperlactatemia septic shock by different lactate markers

Li Wen¹, Ren Shan^1,2, Jiang Li¹, Zhu Bo¹, Jiang Qi¹, Xi Xiuming¹

1. Department of Intensive Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100069, China;
2. Department of Intensive Care Medicine, China Hebei General Hospital, Shijiazhuang 050051, China

Received:2017-11-13 Online:2018-01-21 Published:2018-01-27
Supported by:
This study was supported by National Science-technology Support Plan Projects(2012BAI11B05).

摘要/Abstract

摘要： 目的探讨何种乳酸预测指标（初始乳酸值、乳酸清除率及乳酸曲线下面积）是感染性休克患者14 d病死率的最佳预测指标。方法应用受试者工作特征（receiver operating characteristic，ROC）曲线分析103例感染性休克患者，按预后分为死亡组（81例）和存活组（22例），分别计算两组的初始乳酸值、乳酸清除率及乳酸曲线下面积（area under curve，AUC），比较各乳酸预测指标之间的差别。结果 ROC曲线显示，乳酸曲线下面积及24 h乳酸值可以有效预测14 d病死率，两两比较显示，24 h乳酸值的AUC值明显高于初始乳酸值、乳酸清除率及乳酸曲线下面积。24 h乳酸值预测价值最高（AUC=0.72，P=0.001）。结论 24 h乳酸值是成年高乳酸血症感染性休克患者14 d病死率的有效预测指标，且优于其他乳酸指标。

关键词: 感染性休克, 乳酸, 曲线下面积, 病死率

Abstract: Objective To explore which lactate marker (initial lactate value, lactate clearance and area under the lactate curve) is the best predictor of early mortality in patients with septic shock.Methods According to the prognosis, the patients were divided into nonsurvival and survival group, We compared with the difference between the predicted markers of lactate, and evaluated which kind of lactate marker was the best for early mortality in patients with septic shock.Results The receiver operating characteristic (ROC) curve showed that the area under curve(AUC) of the lactate and 24 h lactate could effectively predict the 14-day mortality. The predicted value was significantly higher than the initial lactate value and lactate clearance rate and the area under curve of the lactate (AUC=0.72,P=0.001).Conclusion Twenty-four hour lactate is the best predictor of 14-day mortality in patients with septic shock, and is superior to other lactate markers.

Key words: septic shock, lactate, area under curve, mortality

中图分类号:

李雯, 任珊, 姜利, 朱波, 姜琦, 席修明. 何种乳酸指标更能有效预测高乳酸血症感染性休克患者14 d病死率[J]. 首都医科大学学报, 2018, 39(1): 9-13.

Li Wen, Ren Shan, Jiang Li, Zhu Bo, Jiang Qi, Xi Xiuming. Prediction of 14 day mortality in patients with hyperlactatemia septic shock by different lactate markers[J]. Journal of Capital Medical University, 2018, 39(1): 9-13.

参考文献

[1] Marshall J C,Vincent J L,Fink M P,et al. Measures,markers, and mediators:toward a staging system for clinical sepsis. A report of the fifth toronto sepsis roundtable, toronto, ontario, canada, October 25-26, 2000[J]. Crit Care Med, 2003, 31(5):1560-1567.
[2] Scott H F, Brou L, Deakyne S J, et al. Association between early lactate levels and 30-day mortality in clinically suspected sepsis in children[J]. JAMA Pediatr, 2017, 171(3):249-255.
[3] Kim Y A, Ha E J, Jhang W K,et al. Early blood lactate area as a prognostic marker in pediatric septic shock[J].Intensive Care Med,2013,39(10):1818-1823.
[4] Dellinger R P, Levy M M, Rhodes A, et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock, 2012[J]. Intensive Care Med,2013, 39(2):165-228.
[5] Nguyen H B, Rivers E P, Knoblich B P,et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock[J]. Crit Care Med,2004,32(8):1637-1642.
[6] Jansen T C, van Bommel J, Woodward R, et al. Association between blood lactate levels, sequential organ failure assessment subscores, and 28-day mortality during early and late intensive care unit stay:a retrospective observational study[J]. Crit Care Med,2009,37(8):2369-2374.
[7] Bakker J, Gris P, Coffernils M, et al. Serial blood lactate levels can predict the development of multiple organ failure following septic shock[J]. Am J Surg, 1996, 171(2):221-226.
[8] BernardinG,Pradier C,Tiger F,et al. Blood pressure and arterial lactate level are early indicators of short term survival in human septic shock[J]. Intensive Care Med, 1996,22(1):17-25.
[9] Jansen T C, van Bommel J, Mulder P G, et al. The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting:a pilot study[J]. Crit Care,2008, 12(6):R160.
[10] Rimachi R, Bruzzi de Carvahlo F, Orellano-Jimenez C, et al. Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock[J]. Anaesth Intensive Care, 2012,40(3):427-432.
[11] Garcia-Alvarez M, Marik P, Bellomo R. Sepsis-associated hyperlactatmia[J]. Crit Care,2014,18(5):503.
[12] Hernandez G, Castro R, Romero C, et al. Persistent sepsis-induced hypotension without hyperlactatemia:is it really septic shock[J]. J Crit Care,2011, 26(4):435.e9-14.
[13] Wacharasint P, Nakada T A, Boyd J H, et al. Normal-range blood lactate concentration in septic shock is prognostic and predictive[J]. Shock,2012, 38(1):4-10.
[14] Singer A J, Taylor M, Domingo A, et al.Diagnostic characteristics of a clinical screening tool in combination with measuring bedside lactate level in emergency department patients with suspected sepsis[J]. Acad Emerg Med,2014, 21(8):853-857.
[15] 崔丽丹,苏军.动态监测血乳酸在脓毒性休克患儿预后评估中的临床价值[J].中国现代药物应用,2012, 6(4):49-50.
[16] Filho R R, Rocha L L, Corrêa T D, et al. Blood lactate levels cutoff and mortality prediction in sepsis-time for a reappraisal? a retrospective cohort study[J]. Shock, 2016,46(5):480-485.
[17] 连晓芳,阎书彩.氧代谢指标在感染性休克中的应用进展[J].临床误诊误治,2015,28(9):110-113.
[18] 夏为,卞晓华,董士民.脓毒症患者的临床特征及死亡相关因素分析[J].解放军医药杂志,2016,28(5):91-96.
[19] 张井晓,尹梅,陈晓梅,等.乳酸曲线下面积对老年脓毒性休克患者预后评估的价值[J].中华医学杂志,2016,96(33):2640-2643.
[20] Suistomma M,Ruokonen E,Kari A,et al. Time-pattern of lactate and lactate to pyruvate ratio in the first 24 hours of intensive care emergency admissions[J].Shock,2000,14(1):8-12.

何种乳酸指标更能有效预测高乳酸血症感染性休克患者14 d病死率

Prediction of 14 day mortality in patients with hyperlactatemia septic shock by different lactate markers

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