Prevalence and characteristics of nonlactate and lactate expressors in septic shock.
Prevalence and characteristics of nonlactate and lactate expressors in septic shock.
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DOI：
10.1016/j.jcrc.2012.01.005
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发表时间：
2012-08
影响因子：
3.7
通讯作者：
Donnino, Michael W.
中科院分区：
文献类型：
--
作者：
Dugas, Andrea Freyer;Mackenhauer, Julie;Salciccioli, Justin D.;Cocchi, Michael N.;Gautam, Shiva;Donnino, Michael W.
该研究的目的是确定血管加压药依赖性脓毒性休克患者中无乳酸血症的比例和患者特征。对2007年12月至2008年9月期间到城市三级急诊科就诊的患者进行了回顾性分析。根据初始乳酸水平，将最终诊断为需要血管加压剂的脓毒性休克患者分为非乳酸表达者（0-2.4 mmol/L）、中间（2.5-3.9 mmol/L）和高（>4.0 mmol/L）乳酸组。在123例血管加压素依赖性感染性休克患者中，55例（45%）为非乳酸表达者（乳酸≤2.4 mmol/L）。急性肝损伤、肝病史和菌血症与乳酸升高相关。几乎一半的血管加压素依赖性感染性休克患者在就诊时不表达乳酸盐，尽管这一人群的死亡率仍然很高。我们发现乳酸表达者和肝脏疾病之间以及乳酸表达者和阳性血培养之间存在显著关联。在感染性休克中，将乳酸血症作为需要额外静脉输液的唯一指标或复苏终点可能是不够的。
The study’s objective was to determine the proportion and patient characteristics of patients in vasopressor-dependent septic shock who presented without lactatemia. A retrospective review of patients presenting to an urban tertiary-care emergency department between December 2007 and September 2008 was conducted. Patients with a final diagnosis of septic shock requiring vasopressors were divided, based on initial lactate, to nonlactate expressors (0–2.4 mmol/L), intermediate (2.5–3.9 mmol/L), and high (>4.0 mmol/L) lactate groups. Among 123 patients with vasopressor-dependent septic shock, 55 (45%) were nonlactate expressors (lactate ≤2.4 mmol/L). Acute liver injury, history of liver disease, and presence of bacteremia were associated with elevated lactate. Almost one-half of patients with vasopressor-dependent septic shock did not express lactate on presentation, although a high mortality rate remains in this population. We found a significant association between lactate expressors and liver disease and between lactate expressors and positive blood cultures. The use of lactatemia as the sole indicator of need for additional intravenous fluid or an end point of resuscitation in septic shock may be inadequate.
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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：
8.8
作者：
Mikkelsen, Mark E.;Miltiades, Andrea N.;Christie, Jason D.
通讯作者：
Christie, Jason D.
影响因子：
4.3
作者：
Jones, Alan E.;Puskarich, Michael A.
通讯作者：
Puskarich, Michael A.
影响因子：
3.7
作者：
Hernandez, Glenn;Castro, Ricardo;Bruhn, Alejandro
通讯作者：
Bruhn, Alejandro
影响因子：
8.8
作者：
ALMENOFF, PL;LEAVY, J;RACKOW, EC
通讯作者：
RACKOW, EC