脓毒症患者血浆乳酸水平轻度升高与病死率相关性研究  

Association of even mild hyperlactatemia with increased mortality in sepsis patients

作　　者：翁云龙[1] 

机构地区：[1]安徽省六安市人民医院重症医学科,237005

出　　处：《中华全科医学》2014年第8期1263-1265,共3页Chinese Journal of General Practice

摘　　要：目的既往的研究表明，乳酸水平高于2mmol／L与预后不良相关，但目前还不清楚当乳酸水平在正常范围内升高对预后的影响。本研究拟比较存活组与死亡组乳酸水平的差异，从而明确乳酸相对增高与死亡率的关系，同时寻找提示预后不良的最佳乳酸值。方法采用回顾性分析，研究对象为107例脓毒症患者，所有患者入院时血乳酸水平均波动在0．5—2．0mmol／L范围。首先根据患者住院期间临床结局将患者分为存活与死亡2组，采用独立样本t检验明确两者乳酸水平是否有统计学差异。用ROC曲线寻找预测患者死亡率的最佳乳酸值，进一步根据该值将患者分为高、低乳酸血症2组，再比较2组患者死亡率是否有统计学差异。结果107例患者中32例死亡75例存活。存活组患者血浆乳酸平均值为（0．8347±0．2310）mmol／L，而死亡组为（1．2188±0．3881），t=14．377，P〈0．001，乳酸水平大于1．15mmol／L时预测患者死亡率的敏感性为59．4％，特异性为90．7％（AUC=0．79，P〈0．001，95％CI=0．687～0．893）。高乳酸血症组患者26例，死亡19例，低乳酸血症患者81例，死亡13例，差异有统计学意义（P〈0．001）。结论入院时患者乳酸水平即使轻度升高（1．16—2．00mmoL／L）也与脓毒症患者死亡率增高相关。当乳酸水平大于1．15mmol／L时提示患者预后不良。Objective Hyperlactatemia（ 〉 2 mmol/L） has been shown to be an independent predictor of mortality in dif- ferent groups of critically ill patients. The clinical significance of elevation of lactate levels within the reference range was not well studied. The objective of this study was to determine the best cutoff threshold for serum lactate within the refer- ence range （0.5 -2.0 mmol/L） that best discriminated between survivors and non-survivors of critical illness .and to ex- amine the association between relative hyperlactatemia（ lactate above the identified threshold） and mortality. Methods This was a retrospective cohort study of aduh patients admitted to the medical-surgical intensive care unit （ICU） of a terti- ary care academic center. Youden index was calculated to identify the best lactate cutoff threshold that discriminated be- tween survivors and non-survivors. Patients with lactate above the identified threshold were defined as having relative hy- perlactatemia. Results During the study period, 107 patients were included in the study,with 32 patients death ,71 cases survival. The wean level of lactate in survival was （ 0. 8347 ± 0.2310 ） mmoL/L, death group was （ 1.2188 ± 0. 3881 ）. There was a significant difference between the two groups（ t = 14. 377 ,P 〈 0. 001 ）. Lactate of 1.15 mmoL/L was found to be the best cutoff threshold for the whole cohort（ AUC = 0.79 ,P 〈 0.001,95% CI = 0. 687-0. 893 ）. 26 patients in relative hyper- lactatemia group,with 19 cases dead,81 patients in lower lactate group, 13 cases died. There was a significant difference between the two groups. Conclusion Relative hyperlactatemia（ lactate of 1.16 -2.00 mmol/L） within the first 24 hours of ICU admission was an independent predictor of hospital and ICU mortality in sepsis patients.

关 键 词：脓毒症 乳酸 病死率 ROC曲线 

分 类 号：R631.2[医药卫生—外科学] R446.11[医药卫生—临床医学]