Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study
Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study
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DOI：
10.1016/s0140-6736(02)07743-7
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发表时间：
2002-02-16
期刊：
影响因子：
168.9
通讯作者：
Wendon, J
中科院分区：
文献类型：
--
作者：
Bernal, W;Donaldson, N;Wendon, J
背景：尽管国王学院医院（KCH）对扑热息痛诱导的急性肝功能衰竭的急诊肝移植选择标准被广泛使用，但需要提高敏感性和促进早期移植的策略。我们调查了动脉血乳酸测量的使用，以识别transplantationcandides.Methods在一个单中心的研究，我们测量动脉血乳酸早期（中位数4小时）和液体复苏后（中位数12小时）的患者入住三级转诊重症监护病房。阈值，最好地确定个人可能会死，而不移植的来源于一个回顾性的初始样本103例对乙酰氨基酚诱导的急性肝衰竭，并应用于一个前瞻性的验证样本107例。结果在初始样本中，在早期样本中，非存活患者的中位乳酸显著高于存活患者（8.5 [范围1.7-21.0] vs 1.4 [0.53-7.9] mmol/L，p
Background Although the King's College Hospital (KCH) selection criteria for emergency liver transplantation in paracetamol-induced acute liver failure are widely used, strategies to improve sensitivity and facilitate earlier transplantation are required. We investigated the use of arterial blood lactate measurement for the identification of transplantation candidates.Methods In a single-centre study, we measured arterial blood lactate early (median 4 h) and after fluid resuscitation (median 12 h) in patients admitted to a tertiary-referral intensive-care unit. Threshold values that best identified individuals likely to die without transplantation were derived in a retrospective initial sample of 103 patients with paracetamol-induced acute liver failure and applied to a prospective validation sample of 107 patients. Predictive value and speed of identification were compared with those of KCH criteria.Findings In the initial sample, median lactate was significantly higher in non-surviving patients than in survivors both in the early samples (8.5 [range 1.7-21.0] vs 1.4 [0.53-7.9] mmol/L, p