入重症监护室时血乳酸水平对脓毒症患者急性肾损伤发生的预测价值  

Predictive value of blood lactic acid level at ICU admission in acute kidney injury patients with sepsis

作　　者：陶丽丽[1] 杨其霖[1] 陈维校 TAO Lili;YANG Qilin;CHEN Weixiao(Intensive Care Unit,Second Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong,510260)

机构地区：[1]广州医科大学附属第二医院重症医学科,广东广州510260

出　　处：《实用临床医药杂志》2021年第14期41-44,53,共5页Journal of Clinical Medicine in Practice

基　　金：广东省医学科研基金项目(B2020094)。

摘　　要：目的对前瞻性FINNAKI研究进行二次分析,探讨入重症监护室(ICU)时血乳酸水平对脓毒症患者12 h后急性肾损伤(AKI)发生的预测价值。方法选取FINNAKI队列研究数据中刚入ICU时未合并AKI的409例脓毒症患者作为研究对象,采用血乳酸三分位数法将其分为低乳酸组、中乳酸组和高乳酸组,比较3组患者12 h后AKI发生率和肾脏替代治疗(RRT)应用情况。采用Logistic回归分析探讨血乳酸水平对AKI发生和应用RRT的预测价值,绘制相应受试者工作特征(ROC)曲线并计算曲线下面积(AUC)。结果低乳酸组、中乳酸组和高乳酸组患者12 h后的AKI发生率分别为21.21%、33.58%和49.65%,差异有统计学意义(P<0.001)。调整变量后的Logistic回归分析结果显示,血乳酸每升高1 mmol/L,脓毒症患者AKI发生风险提高23%(P=0.001)。高乳酸组患者发生AKI的风险是低乳酸组的2.31倍(P=0.010)。ROC曲线分析结果显示,入ICU时血乳酸水平预测脓毒症患者12 h后发生AKI的AUC为0.66(95%CI为0.60~0.72),预测脓毒症AKI患者应用RRT的AUC为0.70(95%CI为0.60~0.80)。结论入ICU时血乳酸水平具有预测脓毒症患者发生AKI和应用RRT的价值。Objective To investigate the predictive value of serum lactic acid level at admission of Intensive Care Unit(ICU)for the occurrence of acute kidney injury(AKI)12 hours after admission by a secondary analysis of the prospective FINNAKI study.Methods A total of 409 sepsis patients without AKI at admission of ICU were selected as study objects from FINNAKI cohort data,and were divided into low level lactic acid group,medium level lactic acid group and high level lactic acid group by blood lactic acid quantile method.The incidence of AKI and the application of renal replacement therapy(RRT)were compared 12 h later in the three groups.Logistic regression analysis was used to investigate the predictive values of serum lactic acid level on the occurrence of AKI and the application of RRT.Receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated.Results The incidence rates of AKI were 21.21%in the low level lactic acid group,33.58%in the medium level lactic acid group and 49.65%in the high level lactic acid group respectively(P<0.001).After adjusting independent variables,multivariate regression analysis showed that risk of AKI increased by 23%for every 1 mmol/L increase of blood lactate in septic patients(P=0.001).The risk of AKI in the high level lactate group was 2.31 times higher than that in the low lactate group(P=0.010).ROC curve showed that the AUC serum lactic acid level at admission in predicting AKI in septic patients was 0.66(95%CI,0.60 to 0.72).The AUC for lactate predicting the use of RRT in septic AKI patients was 0.70(95%CI,0.60 to 0.80).Conclusion Lactate at ICU admission can predict AKI and the use of RRT in septic patients.

关 键 词：重症监护室 血乳酸 急性肾损伤 脓毒症 预测 

分 类 号：R631[医药卫生—外科学] R692[医药卫生—临床医学]