Persistent sepsis-induced hypotension without hyperlactatemia: Is it really septic shock?
Persistent sepsis-induced hypotension without hyperlactatemia: Is it really septic shock?
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DOI：
10.1016/j.jcrc.2010.09.007
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发表时间：
2011-08-01
影响因子：
3.7
通讯作者：
Bruhn, Alejandro
中科院分区：
文献类型：
--
作者：
Hernandez, Glenn;Castro, Ricardo;Bruhn, Alejandro
目的：高乳酸血症对脓毒性休克的预后价值是毋庸置疑的。然而，由于目前的定义不包括高乳酸血症作为一个强制性标准，一些水肿患者可能被诊断为感染性休克，尽管表现出正常乳酸血症。不伴高乳酸血症的持续性脓毒症诱导性低血压的意义尚不清楚。真的是感染性休克吗我们的目的是确定诊断为感染性休克但在进展过程中乳酸水平正常与升高的患者之间的结局差异。我们还探讨了潜在的影响，包括高lactatemia作为一个强制性的诊断criterion.Methods：我们进行了回顾性分析，对一个队列的302脓毒性休克patients.Results：当我们划分患者根据高lactatemia的存在，34%的发展没有高lactatemia，并表现出非常低的死亡率风险（7.7%相比，42.9%的高lactatemia）。这些患者还表现出较轻的器官功能障碍和较高的中心静脉O-2饱和度值，并需要较低的去甲肾上腺素剂量。结论：无高乳酸血症的持续性脓毒症诱导性低血压可能不构成真实的脓毒性休克。我们的研究结果支持需要审查目前的定义感染性休克。高乳酸血症可能是一个客观的参数值得探讨作为一个潜在的诊断标准感染性休克。(C)2011 Elsevier Inc. All rights reserved.
Purpose: The prognostic value of hyperlactatemia in septic shock is unquestionable. However, as current definitions do not include hyperlactatemia as a mandatory criterion, some hypotensive patients may be diagnosed as having septic shock despite exhibiting normolactatemia. The significance of persistent sepsis-induced hypotension without hyperlactatemia is unclear. Is it really septic shock? Our aim was to determine differences in outcome between patients diagnosed as having septic shock but exhibiting normal vs elevated lactate levels during evolution. We also explored the potential implications of including hyperlactatemia as an obligatory diagnostic criterion.Methods: We performed retrospective analyses on a cohort of 302 septic shock patients.Results: When we divided patients according to the presence of hyperlactatemia, 34% evolved without hyperlactatemia and exhibited a very low mortality risk ( 7.7% compared with 42.9% of those with hyperlactatemia). These patients also presented less severe organ dysfunctions and higher central venous O-2 saturation values, and required lower norepinephrine doses. The potential inclusion of hyperlactatemia in septic shock definition would reduce incidence in 34% but increase absolute mortality risk in 11%.Conclusions: Persistent sepsis-induced hypotension without hyperlactatemia may not constitute a real septic shock. Our results support the need to review the current definition of septic shock. Hyperlactatemia could represent an objective parameter worth to be explored as a potential diagnostic criterion for septic shock. (C) 2011 Elsevier Inc. All rights reserved.