Venous lactate levels can be used to identify patients with poor outcome following community-onset norovirus enteritis
Venous lactate levels can be used to identify patients with poor outcome following community-onset norovirus enteritis
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DOI：
10.3109/00365548.2012.686671
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发表时间：
2012-10-01
影响因子：
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通讯作者：
Westin, Johan
中科院分区：
文献类型：
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作者：
Gustavsson, Lars;Andersson, Lars-Magnus;Westin, Johan
背景：诺如病毒性肠炎（NVE）对体弱患者可能是致命的。高血乳酸水平表明灌注不足，并预测许多感染性疾病的死亡率。目的是确定社区发病NVE患者乳酸水平升高的频率及其与死亡率的关系。方法：进行回顾性队列研究。纳入2008年8月至2009年6月期间经聚合酶链反应证实的社区发病NVE的所有住院成人患者。记录到达时的生命体征和静脉乳酸、共病情况和死亡时间。结果指标为30天全因死亡率。结果如下：纳入了82例中位年龄为77岁（四分位距（IQR）53-86岁）的患者，其中47例（57%）为女性，49例（60%）至少有1种主要合并症。45例患者（55%）的乳酸水平高于正常上限（ULN; 1.6 mmol/l）。总的30天死亡率为7%（6/82）。入院时乳酸≥ 2.4 mmol/l（> ULN 50%）的死亡率为18%（5/28），而乳酸< 2.4 mmol/l的死亡率为2%（1/54）（p < 0.05）。死亡患者的中位乳酸水平高于存活患者：分别为4.5（IQR 2.7-7.9）mmol/l vs 1.7（IQR 1.3-2.5）mmol/l（p < 0.01）。乳酸增加1 mmol/l，30天内死亡的校正比值比为2.5（95%置信区间1.003-6.3，p = 0.049）。结论：我们观察到高比例的患者乳酸水平升高的社区发病NVE。乳酸升高可预测死亡率。血乳酸的测量可能是一个有价值的工具，在临床管理与疑似诺如病毒感染的患者。
Background: Norovirus enteritis (NVE) can be fatal in frail patients. High blood lactate levels indicate hypoperfusion and predict mortality in many infectious diseases. The objective was to determine the frequency and association with mortality of elevated lactate levels in patients with community-onset NVE. Methods: A retrospective cohort study was performed. All hospitalized adult patients with community-onset NVE verified by polymerase chain reaction during the period August 2008 to June 2009 were included. Vital signs and venous lactate on arrival, co-morbid conditions, and time of death were registered. The outcome measure was 30-day all-cause mortality. Results: Eighty-two patients with a median age of 77 y (interquartile range (IQR) 53-86 y) were included, of whom 47 (57%) were female and 49 (60%) had at least 1 major co-morbid condition. Lactate levels were above the upper limit of normal (ULN; 1.6 mmol/l) in 45 patients (55%). The overall 30-day mortality rate was 7% (6/82). Mortality was 18% (5/28) with lactate >= 2.4 mmol/l (> 50% above the ULN) on admission compared to 2% (1/54) with lactate < 2.4 mmol/l (p < 0.05). Patients who died had a higher median lactate level compared to survivors: 4.5 (IQR 2.7-7.9) mmol/l vs 1.7 (IQR 1.3-2.5) mmol/l, respectively (p < 0.01). The adjusted odds ratio for death within 30 days for a 1 mmol/l increase in lactate was 2.5 (95% confidence interval 1.003-6.3, p = 0.049). Conclusions: We observed a high proportion of patients with elevated lactate levels in community-onset NVE. Lactate elevation could predict mortality. Measurement of blood lactate may be a valuable tool in the clinical management of patients with a suspected norovirus infection.