Liver cirrhosis affects serum lactate level measurement while assessing disease severity in patients with sepsis.
Liver cirrhosis affects serum lactate level measurement while assessing disease severity in patients with sepsis.
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DOI：
10.1097/meg.0000000000001826
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发表时间：
2021-09-01
影响因子：
2.1
通讯作者：
Su CM
中科院分区：
文献类型：
--
作者：
Cheng CY;Kung CT;Wu KH;Chen FC;Cheng HH;Cheng FJ;Huang JB;Su CM
血清乳酸升高与脓毒症的高死亡率相关，而肝功能障碍与血清乳酸水平升高相关。我们评估了血清乳酸在肝硬化和脓毒症患者中的预测能力。这项回顾性研究纳入了2007年1月至2013年12月期间抽取初始血清血乳酸的12281例疑似感染病例。采用一对二倾向评分匹配分析，分别成功匹配了1053例和2106例伴有和不伴有基础肝硬化的脓毒症患者。无肝硬化（WLC）患者的存活者和非存活者的乳酸水平分别为2.58和5.93 mmol/L，非失代偿期肝硬化（NDLC）患者的乳酸水平分别为2.96和7.29 mmol/L，失代偿期肝硬化（DLC）患者的乳酸水平分别为4.08和7.16 mmol/L。在受试者工作特征曲线分析中，使用血清乳酸水平>2.0 mmol/L，WLC组预测死亡率的敏感性和特异性分别为0.81和0.55，NDLC组分别为0.85和0.45，DLC组分别为0.86和0.33。血清乳酸水平可用于预测肝硬化患者脓毒症的严重程度，但其特异性在2.0 mmol/L时较低。
Elevated serum lactate is associated with higher mortality in sepsis, whereas liver dysfunction is associated with higher serum lactate levels. We assessed the predictive ability of serum lactate in patients with liver cirrhosis and sepsis. This retrospective study included 12 281 cases of suspected infection with initial serum blood lactate drawn during January 2007–December 2013. Using one-to-two propensity score matching analysis, 1053 and 2106 septic patients with and without underlying liver cirrhosis, respectively, were successfully matched. Lactate levels of survivors and nonsurvivors were 2.58 and 5.93 mmol/L, respectively, in patients without liver cirrhosis (WLC), 2.96 and 7.29 mmol/L, respectively, in patients with nondecompensated liver cirrhosis (NDLC), and 4.08 and 7.16 mmol/L, respectively, in patients with decompensated liver cirrhosis (DLC). In receiver operating characteristic curve analysis, the sensitivity and specificity for predicting mortality were 0.81 and 0.55, respectively, in the WLC group, 0.85 and 0.45, respectively, in the NDLC group, and 0.86 and 0.33, respectively, in the DLC group, using serum lactate levels >2.0 mmol/L. The serum lactate level can be used to predict the severity of sepsis in patients with liver cirrhosis; however, its specificity would be lower at a cutoff of 2.0 mmol/L.