Serum lactate and mean arterial pressure thresholds in patients with cirrhosis and septic shock.
Serum lactate and mean arterial pressure thresholds in patients with cirrhosis and septic shock.
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DOI：
10.1097/hc9.0000000000000353
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发表时间：
2024-01-01
影响因子：
5.1
通讯作者：
中科院分区：
文献类型：
--
作者：
脓毒症-3指南在脓毒性休克定义中纳入了血清乳酸水平>2 mmol/L，以解释观察到的较高死亡率。需要进一步的证据来支持肝硬化的这一阈值，以及复苏期间的目标平均动脉压（MAP）。这项观察性队列研究调查了初始血清乳酸和复苏MAP水平与肝硬化和非肝硬化患者住院死亡率之间的关系。纳入了2006年至2021年期间在四级学术中心因感染性休克而入住重症监护室的患者。将影像学和国际疾病分类编码记录的肝硬化患者（n=595）与无肝硬化患者（n=575）进行比较。重症监护室入院乳酸水平和中位2小时MAP与住院死亡率和连续性肾脏替代治疗需求的相关性进行了评估。事后分析中位24小时MAP和住院死亡率之间的关系。在肝硬化组中，与乳酸<2 mmol/L相比，入院时乳酸水平为2-4和>4 mmol/L与院内死亡率增加相关[校正比值比（aOR）：1.69，CI：1.03-2.81，aOR：4.02，CI：2.53-6.52]。中位24小时MAP 60-65和<60 mm Hg were also associated with increased in-hospital mortality compared with MAP >65 mm Hg（aOR：2.84，CI：1.64-4.92和aOR：7.34，CI：3.17-18.76）。在非肝硬化组中，乳酸2-4和>4 mmol/L与住院死亡率的相关性较弱（aOR：1.32，CI：0.77-2.27和aOR：2.25，CI：1.40-3.67）和中位24小时MAP 60-65和<60 mm Hg（aOR：1.70，CI：0.65-4.14和aOR：4.41，CI：0.79-29.38）。这些发现支持在脓毒性休克的定义中使用乳酸>2 mmol/L，以及在肝硬化患者复苏期间使用目标MAP>65 mm Hg。
The Sepsis-3 guidelines have incorporated serum lactate levels of >2 mmol/L in septic shock definition to account for higher observed mortality. Further evidence is needed to support this threshold in cirrhosis, as well as target mean arterial pressure (MAP) during resuscitation. This observational cohort study investigated the association between initial serum lactate and resuscitation MAP levels on in-hospital mortality in patients with and without cirrhosis. Patients admitted to the intensive care unit for the treatment of septic shock between 2006 and 2021 in a quaternary academic center were included. Patients with cirrhosis documented on imaging and International Classification of Disease codes (n=595) were compared to patients without cirrhosis (n=575). The association of intensive care unit admission lactate levels and median 2-hour MAP with in-hospital mortality and the need for continuous renal replacement therapy was assessed. The association between median 24-hour MAP and in-hospital mortality was analyzed post hoc. Within the cirrhosis group, admission lactate levels of 2–4 and >4 mmol/L were associated with increased in-hospital mortality compared to lactate <2 mmol/L [adjusted odds ratio (aOR): 1.69, CI: 1.03–2.81, aOR: 4.02, CI: 2.53–6.52]. Median 24-hour MAP 60–65 and <60 mm Hg were also associated with increased in-hospital mortality compared with MAP >65 mm Hg (aOR: 2.84, CI: 1.64–4.92 and aOR: 7.34, CI: 3.17–18.76). In the noncirrhosis group, associations with in-hospital mortality were weaker for lactate 2–4 and >4 mmol/L (aOR: 1.32, CI: 0.77–2.27 and aOR: 2.25, CI: 1.40–3.67) and median 24-hour MAP 60–65 and <60 mm Hg (aOR: 1.70, CI: 0.65–4.14 and aOR: 4.41, CI: 0.79–29.38). These findings support utilizing lactate >2 mmol/L in the definition of septic shock, as well as a target MAP of >65 mm Hg during resuscitation in patients with cirrhosis.
肝硬化和败血性休克患者护理中的新兴概念。
影响因子：
2.4
作者：
Jimenez JV;Garcia-Tsao G;Saffo S
通讯作者：
Saffo S
影响因子：
1.8
作者：
Tongyoo S;Sutthipool K;Viarasilpa T;Permpikul C
通讯作者：
Permpikul C