Early Lactate Clearance Is Associated With Improved Outcomes in Patients With Postcardiac Arrest Syndrome: A Prospective, Multicenter Observational Study (SOS-KANTO 2012 Study)
Early Lactate Clearance Is Associated With Improved Outcomes in Patients With Postcardiac Arrest Syndrome: A Prospective, Multicenter Observational Study (SOS-KANTO 2012 Study)
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DOI：
10.1097/ccm.0000000000002307
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发表时间：
2017-06-01
影响因子：
8.8
通讯作者：
Morimura, Naoto
中科院分区：
文献类型：
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作者：
Hayashida, Kei;Suzuki, Masaru;Morimura, Naoto
目的：为了确定早期乳酸减少是否与院外心脏骤停患者的生存率提高和良好的神经功能结局相关。设计：前瞻性多中心观察性研究的特设数据分析。设置：2012年1月至2013年3月期间日本关东67家急诊医院的院外心脏骤停患者。患者：成功复苏后入院的院外心脏骤停的成人患者被identified.Interventions：入院时和入院后6 h测量血乳酸浓度。早期乳酸清除率定义为基线测量后6小时乳酸水平的百分比变化。测量和主要结果：543例患者（平均年龄65 ± 16岁; 72.6%为男性）的平均乳酸清除率为42.4% ± 53.7%。总的30天生存率和良好的神经功能结局分别为47.1%和27.4%。存活率随乳酸清除率的增加而增加（四分位数1，29.4%;四分位数2，42.6%;四分位数3，51.5%;四分位数4，65.2%; p < 0.001）。多因素Logistic回归分析显示，乳酸清除率四分位数是30天生存率和良好神经功能结局的独立预测因子。在考克斯比例风险模型中，乳酸清除率在第1个四分位数的患者30天内的死亡率显著较高（风险比，3.12; 95% CI，2.14-4.53），四分位数2（风险比，2.13; 95%CI，1.46-3.11）和四分位数3（风险比，1.49; 95%CI，1.01-2.19）的患者比乳酸清除率在四分位数4的患者更易发生乳酸清除。此外，多变量Logistic回归分析显示，乳酸清除率是一个显着的预测良好的神经功能的结果在30天后入院conclusions：有效的乳酸减少在第一个6小时的心脏骤停后护理与独立的初始乳酸水平的生存和良好的神经功能的结果。
Objectives: To determine whether early lactate reduction is associated with improved survival and good neurologic outcome in patients with out-of-hospital cardiac arrest.Design: Ad hoc data analysis of a prospective, multicenter observational study.Setting: Out-of-hospital cardiac arrest patients at 67 emergency hospitals in Kanto, Japan between January 2012 and March 2013.Patients: Adult patients with out-of-hospital cardiac arrest admitted to the hospital after successful resuscitation were identified.Interventions: Blood lactate concentrations were measured at hospital admission and 6 h after hospital admission. Early lactate clearance was defined as the percent change in lactate level 6 h after a baseline measurement.Measurements and Main Results: The 543 patients (mean age, 65 +/- 16 yr; 72.6% male) had a mean lactate clearance of 42.4% +/- 53.7%. Overall 30-day survival and good neurologic outcome were 47.1% and 27.4%, respectively. The survival proportion increased with increasing lactate clearance (quartile 1, 29.4%; quartile 2, 42.6%; quartile 3, 51.5%; quartile 4, 65.2%; p < 0.001). Multivariate logistic regression analysis showed that lactate clearance quartile was an independent predictor of the 30-day survival and good neurologic outcome. In the Cox proportional hazards model, the frequency of mortality during 30 days was significantly higher for patients with lactate clearance in quartile 1 (hazard ratio, 3.12; 95% CI, 2.14-4.53), quartile 2 (hazard ratio, 2.13; 95% CI, 1.46-3.11), and quartile 3 (hazard ratio, 1.49; 95% CI, 1.01-2.19) than those with lactate clearance in quartile 4. Furthermore, multivariate logistic regression analysis revealed that lactate clearance was a significant predictor of good neurologic outcome at 30 days after hospital admission.Conclusions: Effective lactate reduction over the first 6 hours of postcardiac arrest care was associated with survival and good neurologic outcome independently of the initial lactate level.