Dynamic lactate indices as predictors of outcome in critically ill patients.
Dynamic lactate indices as predictors of outcome in critically ill patients.
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DOI：
10.1186/cc10497
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Bellomo R
中科院分区：
文献类型：
--
作者：
Nichol A;Bailey M;Egi M;Pettila V;French C;Stachowski E;Reade MC;Cooper DJ;Bellomo R
在危重病人中乳酸浓度的动态变化可能比静态指标更准确地预测患者的预后。我们的目的是比较乳酸血症的动态指标的预测价值在第一个24小时的重症监护病房（ICU）入院更常用的静态指标的价值。这是一项回顾性观察性研究，前瞻性获得了来自澳大利亚四所大学医院的5，041例连续危重患者的重症监护数据库。我们评估了ICU入院前24小时内收集的动态乳酸值与ICU和住院死亡率之间的关系。我们在5，041名患者入住ICU的前24小时内获得了36，673个乳酸测量值。前24小时内的时间加权平均乳酸盐（LACTW 24）和乳酸盐变化（LACΔ24）均可独立预测住院死亡率，两种关系似乎都是线性的。LACTW 24和LACΔ24每增加1个单位，住院死亡风险分别增加37%（OR 1.37，1.29 ~ 1.45; P < 0.0001）和15%（OR 1.15，1.10 ~ 1.20; P < 0.0001）。当这些动态指标与急性生理学和慢性健康评估II（APACHE II）评分相结合时，改善了总体结果预测（P < 0.0001），达到近90%的准确性。当考虑前24小时内的所有乳酸测量时，LACTW 24和LACΔ24的组合显著优于（P < 0.0001）乳酸浓度的静态指标，例如入院乳酸、最大乳酸和最小乳酸。在ICU入院后的前24小时内，高乳酸血症的动态指标具有显著的独立预测价值，提高了基于疾病严重程度评分的结局预测的性能，并且上级乳酸浓度的简单静态指标。
Dynamic changes in lactate concentrations in the critically ill may predict patient outcome more accurately than static indices. We aimed to compare the predictive value of dynamic indices of lactatemia in the first 24 hours of intensive care unit (ICU) admission with the value of more commonly used static indices. This was a retrospective observational study of a prospectively obtained intensive care database of 5,041 consecutive critically ill patients from four Australian university hospitals. We assessed the relationship between dynamic lactate values collected in the first 24 hours of ICU admission and both ICU and hospital mortality. We obtained 36,673 lactate measurements in 5,041 patients in the first 24 hours of ICU admission. Both the time weighted average lactate (LACTW24) and the change in lactate (LACΔ24) over the first 24 hours were independently predictive of hospital mortality with both relationships appearing to be linear in nature. For every one unit increase in LACTW24 and LACΔ24 the risk of hospital death increased by 37% (OR 1.37, 1.29 to 1.45; P < 0.0001) and by 15% (OR 1.15, 1.10 to 1.20; P < 0.0001) respectively. Such dynamic indices, when combined with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, improved overall outcome prediction (P < 0.0001) achieving almost 90% accuracy. When all lactate measures in the first 24 hours were considered, the combination of LACTW24 and LACΔ24 significantly outperformed (P < 0.0001) static indices of lactate concentration, such as admission lactate, maximum lactate and minimum lactate. In the first 24 hours following ICU admission, dynamic indices of hyperlactatemia have significant independent predictive value, improve the performance of illness severity score-based outcome predictions and are superior to simple static indices of lactate concentration.
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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：
158.5
作者：
Rivers, E;Nguyen, B;Tomlanovich, M
通讯作者：
Tomlanovich, M
影响因子：
3.1
作者：
Suistomaa, M;Ruokonen, E;Takala, J
通讯作者：
Takala, J
影响因子：
8.8
作者：
Mikkelsen, Mark E.;Miltiades, Andrea N.;Christie, Jason D.
通讯作者：
Christie, Jason D.
影响因子：
8.8
作者：
Levy, B;Sadoune, LO;Larcan, A
通讯作者：
Larcan, A