The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study.
The effect of liver disease on lactate normalization in severe sepsis and septic shock: a cohort study.
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DOI：
10.15441/ceem.15.025
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发表时间：
2015-12
影响因子：
1.9
通讯作者：
Jones AE
中科院分区：
文献类型：
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作者：
Sterling SA;Puskarich MA;Jones AE
目的探讨肝脏疾病（LD）对脓毒症早期复苏中乳酸清除的影响。这是一项多中心随机临床试验。初始乳酸浓度为2 mmol/L，随后在6小时内测定血清乳酸浓度。LD分为两类：1)既往病史（PMH）分为无LD、轻度LD（无Child评分标准，但有乙型/丙型肝炎PMH）、肝硬化；2)可测量的肝功能障碍，由顺序器官衰竭评估（L-SOFA）的肝脏成分评分确定为无功能障碍（L-SOFA评分0），轻度功能障碍（评分1），中重度功能障碍（评分2至4）。主要观察指标为乳酸正常化率。纳入187例患者。按PMH分类，169例无LD， 6例轻度LD， 12例肝硬化。无LD患者中63/169（37%）达到乳酸正常化，轻度LD患者为4/6(67%)，肝硬化患者为1/12 (8%)（P<0.03）。按L-SOFA评分分类，L-SOFA 0组患者中有59/124例（47%）达到乳酸正常化，L-SOFA 1组为6/31例（19%），L-SOFA 2-4组为3/32例（9%）（P<0.01）。相对乳酸清除率[（初始乳酸-随后乳酸）/初始乳酸]在PMH较晚期LD患者中较低（37.7 vs. 40.4 vs. 21.8， P=0.07），随着L-SOFA评分的增加而降低（42.0 vs. 30.1 vs. 23.4， P=0.01）。在败血症的早期复苏过程中，肝功能障碍与乳酸清除和正常化受损显著相关。
To describe the effect of liver disease (LD) on lactate clearance during early sepsis resuscitation. This is a multicenter randomized clinical trial. An initial lactate >2 mmol/L and subsequent serum lactate measurement within 6 hours were required for inclusion. LD was categorized by two methods: 1) past medical history (PMH) categorized as no LD, mild LD (no Child’s score criteria, but PMH of hepatitis B/C), cirrhosis; and 2) measurable liver dysfunction determined by the liver component of the sequential organ failure assessment (L-SOFA) score as no dysfunction (L-SOFA score 0), mild dysfunction (score 1), moderate-severe dysfunction (score 2 to 4). Primary outcome was the rate of lactate normalization. One hundred eighty-seven patients were included. When categorized by PMH, 169 patients had no LD, 6 mild LD, and 12 cirrhosis. 63/169 (37%) of patients with no LD achieved lactate normalization, compared to 4/6 (67%) with mild LD, and 1/12 (8%) with cirrhosis (P<0.03). Categorized by L-SOFA score, 59/124 (47%) patients with L-SOFA 0 achieved lactate normalization, compared to 6/31 (19%) with L-SOFA 1, and 3/32 (9%) with L-SOFA 2–4 (P<0.01). Relative lactate clearance [(initial lactate–subsequent lactate)/initial lactate] was lower in patients with more advanced LD by PMH (37.7 vs. 40.4 vs. 21.8, P=0.07), and lower with increasing L-SOFA score (42.0 vs. 30.1 vs. 23.4, P=0.01). Liver dysfunction was significantly associated with impaired lactate clearance and normalization during the early resuscitation of sepsis.