Early lactate clearance is associated with improved outcome in severe sepsis and septic shock
Early lactate clearance is associated with improved outcome in severe sepsis and septic shock
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DOI：
10.1097/01.ccm.0000132904.35713.a7
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发表时间：
2004-08-01
影响因子：
8.8
通讯作者：
Tomlanovich, MC
中科院分区：
文献类型：
--
作者：
Nguyen, HB;Rivers, EP;Tomlanovich, MC
目的：系列乳酸浓度可用于检查重症监护室中疾病的严重程度。本研究探讨了重症监护病房入院前（疾病出现的最近时期）乳酸清除率作为严重脓毒症和脓毒性休克结局指标的临床实用性。我们假设6小时内高乳酸清除率与死亡率降低相关。设计：前瞻性观察研究。设置：城市急诊科和重症监护病房超过1年的时间。严重脓毒症或脓毒性休克患者的便利队列研究。治疗在急诊科开始，并在重症监护室继续，包括中心静脉和动脉导管插入术，抗生素，液体复苏，机械通气，血管加压药，并在适当时使用强心剂。测量和主要结果：在0小时获得生命体征、实验室值和急性生理学和慢性健康评价（APACHE）II评分（急诊科介绍）、第6小时和住院后的前72小时。记录急诊科和重症监护室给予的治疗。乳酸盐清除率定义为从急诊科就诊至第6小时乳酸盐减少的百分比。进行Logistic回归分析，以确定与死亡率相关的独立变量。入组了111例患者，平均年龄为64.9 ± 16.7岁，急诊科住院时间为6.3 ± 3.2小时，总体住院死亡率为42.3%。基线APACHE II评分为20.2 +/- 6.8，乳酸盐为6.9 +/- 4.6 mmol/L。存活者与非存活者相比，乳酸清除率分别为38.1 +/- 34.6 vs. 12.0 +/-51.6%（p = 0.005）。统计学显著性单变量变量的多变量logistic回归分析显示乳酸清除率与死亡率呈显著负相关（p = 0.04）。乳酸清除率每增加10%，死亡率可能性降低约11%。乳酸清除率大于或等于10%的患者（相对于乳酸清除率
Objective: Serial lactate concentrations can be used to examine disease severity in the intensive care unit. This study examines the clinical utility of the lactate clearance before intensive care unit admission (during the most proximal period of disease presentation) as an indicator of outcome in severe sepsis and septic shock. We hypothesize that a high lactate clearance in 6 hrs is associated with decreased mortality rate.Design: Prospective observational study.Setting: An urban emergency department and intensive care unit over a 1-yr period.Patients. A convenience cohort of patients with severe sepsis or septic shock.Interventions. Therapy was initiated in the emergency department and continued in the intensive care unit, including central venous and arterial catheterization, antibiotics, fluid resuscitation, mechanical ventilation, vasopressors, and inotropes when appropriate.Measurements and Main Results: Vital signs, laboratory values, and Acute Physiology and Chronic Health Evaluation (APACHE) II score were obtained at hour 0 (emergency department presentation), hour 6, and over the first 72 hrs of hospitalization. Therapy given in the emergency department and intensive care unit was recorded. Lactate clearance was defined as the percent decrease in lactate from emergency department presentation to hour 6. Logistic regression analysis was performed to determine independent variables associated with mortality. One hundred and eleven patients were enrolled with mean age 64.9 +/- 16.7 yrs, emergency department length of stay 6.3 +/- 3.2 hrs, and overall in-hospital mortality rate 42.3%. Baseline APACHE II score was 20.2 +/- 6.8 and lactate 6.9 +/- 4.6 mmol/L. Survivors compared with nonsurvivors had a lactate clearance of 38.1 +/- 34.6 vs. 12.0 +/- 51.6%, respectively (p = .005). Multivariate logistic regression analysis of statistically significant univariate variables showed lactate clearance to have a significant inverse relationship with mortality (p = .04). There was an approximately 11% decrease likelihood of mortality for each 10% increase in lactate clearance. Patients with a lactate clearance greater than or equal to10%, relative to patients with a lactate clearance