血乳酸升高是脓毒症相关性急性肾损伤发生及死亡的独立危险因素  

Elevated serum lactic acid level is an independent risk factor for the incidence and mortality of sepsis-associated acute kidney injury

作　　者：龚春蕾 蒋远霞 唐艳 刘福岗 史应龙[2] 周红卫[2] 谢恺庆[1] Gong Chunlei;Jiang Yuanxia;Tang Yan;Liu Fugang;Shi Yinglong;Zhou Hongwei;Xie Kaiqing(Department of Blood Purification,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,Guangxi Zhuang Autonomous Region,China;Department of Blood Purification,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第二附属医院血液净化部,南宁530007 [2]广西医科大学第一附属医院血液净化部,南宁530021

出　　处：《中华危重病急救医学》2022年第7期714-720,共7页Chinese Critical Care Medicine

基　　金：广西壮族自治区自然科学基金(2018GXNSFAA050057)。

摘　　要：目的探讨血乳酸(Lac)对脓毒症患者发生急性肾损伤(AKI)的影响, 以及Lac是否会影响脓毒症相关性AKI患者院内病死率。方法采用回顾性队列研究方法, 收集2014年3月至2019年6月入住广西医科大学第一附属医院内科重症监护病房(ICU)及2017年1月至2020年6月入住广西医科大学第二附属医院ICU的脓毒症患者的临床资料。根据入ICU 24 h内首次Lac的四分位数将患者分为Lac≤1.4 mmol/L组(Q_(1)组)、Lac 1.5~2.4 mmol/L组(Q_(2)组)、Lac 2.5~4.0 mmol/L组(Q_(3)组)和Lac≥4.1 mmol/L组(Q_(4)组), 比较4组患者入ICU后脓毒症相关性AKI的发生率及院内病死率;通过二分类多因素Logistic回归分析探讨Lac升高对脓毒症相关性AKI发生及死亡的影响。绘制受试者工作特征曲线(ROC曲线), 分析Lac对脓毒症相关性AKI发生及死亡的预测价值, 获得截断值, 分析不同Lac水平时脓毒症相关性AKI的发生及死亡风险。结果 655例脓毒症患者均纳入分析, 其中330例(50.4%)发生AKI, 325例(49.6%)未发生AKI;330例脓毒症相关性AKI患者中, 死亡134例(40.6%), 存活196例(59.4%)。随着Lac水平升高, 脓毒症相关性AKI发生率逐渐升高(Q_(1)~Q_(4)组分别为34.5%、41.0%、58.4%、66.3%), 且院内病死率亦逐渐升高(Q_(1)~Q_(4)组分别为23.4%、29.2%、33.1%、43.4%), 差异均有统计学意义(均P<0.01)。与非AKI组相比, AKI组脓毒症患者Lac水平显著升高〔mmol/L:3.08(1.84, 5.70)比1.91(1.20, 3.10), P<0.01〕;校正性别(男性)、感染部位(腹腔)、血管活性药物、基线机械通气、平均动脉压(MAP)、基础肾功能不全、尿酸、降钙素原(PCT)、血小板计数(PLT)、基线血肌酐(SCr)、基础估算肾小球滤过率(eGFR)等影响因素后, 多因素Logistic回归分析表明, Lac升高是脓毒症相关性AKI发生的独立危险因素〔优势比(OR)=1.096, 95%可信区间(95%CI)为1.022~1.175, P=0.010〕。与存活组相比, 死亡组脓毒症相关性AKI患者Lac水平显著升高�Objective To explore the effect of serum lactic acid(Lac)level on acute kidney injury(AKI)in patients with sepsis and whether Lac level affects the in-hospital mortality of patients with sepsis-associated AKI.Methods A retrospective cohort study was conducted.Clinical data of patients with sepsis admitted to the internal intensive care unit(ICU)of the First Affiliated Hospital of Guangxi Medical University from March 2014 to June 2019 and the ICU of the Second Affiliated Hospital of Guangxi Medical University from January 2017 to June 2020 were collected.According to the first quartile of Lac within 24 hours of admission to ICU,the patients were divided into Lac≤1.4 mmol/L group(group Q_(1)),Lac 1.5-2.4 mmol/L group(group Q_(2)),Lac 2.5-4.0 mmol/L group(group Q_(3)),and Lac≥4.1 mmol/L group(group Q_(4)).The incidence of sepsis-associated AKI after admission to ICU and hospital mortality were compared among four groups.The effect of elevated Lac on the incidence and mortality of sepsis-associated AKI was investigated by binary Logistic regression analysis.The receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of Lac on the incidence and mortality of sepsis-associated AKI,and the cut-off value was obtained to analyze the incidence and death risk of sepsis-associated AKI at different Lac levels.Results A total of 655 sepsis patients were enrolled,of which 330 patients(50.4%)developed AKI and 325 patients(49.6%)did not.Among 330 patients with sepsis-associated AKI,134(40.6%)died and 196(59.4%)survived.With the increase of Lac level,the incidence of sepsis-associated AKI increased gradually(34.5%,41.0%,58.4%,66.3%,respectively,in group Q_(1)-Q_(4)),meanwhile,the in-hospital mortality also increased gradually(23.4%,29.2%,33.1%,43.4%,respectively,in group Q_(1)-Q_(4)),the differences were statistically significant(both P<0.01).Compared with the non-AKI group,the Lac level in the AKI group was significantly increased[mmol/L:3.08(1.84,5.70)vs.1.91(1.20,3.10),P<0.01].After adjust

关 键 词：乳酸 脓毒症 急性肾损伤 危险因素 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]