Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock.
Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock.
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DOI：
10.4266/acc.2021.00332
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发表时间：
2022-03
影响因子：
1.8
通讯作者：
Permpikul C
中科院分区：
文献类型：
--
作者：
Tongyoo S;Sutthipool K;Viarasilpa T;Permpikul C
在肝硬化合并感染性休克患者中，肝功能受损可能会减少乳酸清除并产生较高的乳酸水平。本研究调查了急性和非急性感染性休克患者之间初始乳酸、乳酸清除率和乳酸利用率的差异。这是一项回顾性队列研究，在一所大学附属医学中心进行。我们招募了2012年至2018年期间住院的成年人，他们符合败血症生存运动：2012年的败血性休克诊断标准。先前通过影像学诊断为肝硬化的患者被归类为肝硬化组。测量初始乳酸水平和复苏后6小时的水平，并用于计算乳酸清除率。我们比较了肝硬化组和非肝硬化组之间的初始乳酸盐、6小时乳酸盐和乳酸盐清除率。主要结局为住院死亡率。共入组777例患者，其中91例先前诊断为肝硬化。肝硬化患者的初始乳酸和6小时乳酸均显著较高，但两组之间的乳酸清除率无差异。对院内死亡率预测因子的受试者工作特征曲线分析显示，在非肝硬化患者中，初始乳酸、6小时乳酸和乳酸清除率的截止值分别为>4 mmol/L、>2 mmol/L和<10%。在肝硬化患者中，预测住院死亡率的截止值分别为>5 mmol/L、>5 mmol/L和<20%。乳酸水平和乳酸清除率均不是败血症和非败血症感染性休克患者院内死亡率的独立危险因素。肝硬化患者的初始乳酸水平和6小时乳酸水平显著高于非肝硬化患者。
In septic shock patients with cirrhosis, impaired liver function might decrease lactate elimination and produce a higher lactate level. This study investigated differences in initial lactate, lactate clearance, and lactate utility between cirrhotic and non-cirrhotic septic shock patients. This is a retrospective cohort study conducted at a referral, university-affiliated medical center. We enrolled adults admitted during 2012–2018 who satisfied the septic shock diagnostic criteria of the Surviving Sepsis Campaign: 2012. Patients previously diagnosed with cirrhosis by an imaging modality were classified into the cirrhosis group. The initial lactate levels and levels 6 hours after resuscitation were measured and used to calculate lactate clearance. We compared initial lactate, lactate at 6 hours, and lactate clearance between the cirrhosis and non-cirrhosis groups. The primary outcome was in-hospital mortality. Overall 777 patients were enrolled, of whom 91 had previously been diagnosed with cirrhosis. Initial lactate and lactate at 6 hours were both significantly higher in cirrhosis patients, but there was no difference between the groups in lactate clearance. A receiver operating characteristic curve analysis for predictors of in-hospital mortality revealed cut-off values for initial lactate, lactate at 6 hours, and lactate clearance of >4 mmol/L, >2 mmol/L, and <10%, respectively, among non-cirrhosis patients. Among patients with cirrhosis, the cut-off values predicting in-hospital mortality were >5 mmol/L, >5 mmol/L, and <20%, respectively. Neither lactate level nor lactate clearance was an independent risk factor for in-hospital mortality among cirrhotic and non-cirrhotic septic shock patients. The initial lactate level and lactate at 6 hours were significantly higher in cirrhosis patients than in non-cirrhosis patients.
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影响因子：
120.7
作者：
Jones, Alan E.;Shapiro, Nathan I.;Trzeciak, Stephen;Arnold, Ryan C.;Claremont, Heather A.;Kline, Jeffrey A.
通讯作者：
Kline, Jeffrey A.
影响因子：
1.9
作者：
Sterling SA;Puskarich MA;Jones AE
通讯作者：
Jones AE
影响因子：
8.8
作者：
Kethireddy, Shravan;Bilgili, Beliz;Kumar, Anand
通讯作者：
Kumar, Anand
影响因子：
8.8
作者：
Ryoo, Seung Mok;Lee, JungBok;Kim, Won Young
通讯作者：
Kim, Won Young
影响因子：
13.5
作者：
Fernández, J;Navasa, M;Rodés, J
通讯作者：
Rodés, J