Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock
Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock
复制标题
DOI：
10.1097/ccm.0b013e31819fcf68
复制
发表时间：
2009-05-01
影响因子：
8.8
通讯作者：
Christie, Jason D.
中科院分区：
文献类型：
--
作者：
Mikkelsen, Mark E.;Miltiades, Andrea N.;Christie, Jason D.
原理：血清乳酸盐是对严重脓毒症患者进行风险分层的潜在有用的生物标志物;然而，血清乳酸盐升高仅仅是临床明显器官功能障碍和/或休克的表现（即，难治性低血压）。目的：为了检验严重脓毒症患者急诊（艾德）的初始血清乳酸水平与死亡率之间的相关性是否独立于器官功能障碍和休克。设计：单中心队列研究。主要结局为28天死亡率，风险因素变量为初始静脉乳酸（mmol/L），归类为低（≥ 4）。潜在的协变量包括年龄、性别、种族、急性和慢性器官功能障碍、疾病严重程度和早期目标导向治疗的开始。多变量logistic回归分析根据休克的存在与否进行分层。设置：2005年至2007年在一家学术三级护理中心的艾德。患者：830名成人因严重脓毒症在艾德住院。干预：无。测量和主要结果：28天死亡率为22.9%，血清乳酸中位数为2.9 mmol/L。在非休克亚组中，中度（比值比[OR] = 2.05，p = 0.024）和高血清乳酸水平（OR = 4.87，p < 0.001）与死亡率相关。在休克亚组中，中等（OR = 3.27，p = 0.022）和高血清乳酸水平（OR = 4.87，p = 0.001）也与死亡率相关。调整潜在的混杂因素后，中间和高血清乳酸水平仍然显着相关的死亡率休克和nonshock strates.Conclusions：初始血清乳酸与死亡率独立的临床明显的器官功能障碍和休克的严重脓毒症患者入院的艾德。中等和高血清乳酸水平与死亡率独立相关。(Crit Care Med 2009; 37：1670-1677）
Principle: Serum lactate is a potentially useful biomarker to risk-stratify patents with severe sepsis; however, it is plausible that elevated serum lactate is simply a manifestation of clinically apparent organ dysfunction and/or shock (i.e., refractory hypotension).Objective: To test whether the association between initial serum lactate level and mortality in patients presenting to the emergency department (ED) with severe sepsis is independent of organ dysfunction and shock.Design: Single-center cohort study. The primary outcome was 28-day mortality and the risk factor variable was initial venous lactate (mmol/L), categorized as low (= 4). Potential covariates included age, sex, race, acute and chronic organ dysfunction, severity of illness, and initiation of early goal-directed therapy. Multivariable logistic regression analyses were stratified on the presence or absence of shock.Setting: The ED of an academic tertiary care center from 2005 to 2007.Patients: Eight hundred thirty adults admitted with severe sepsis in the ED.Interventions: None.Measurements and Main Results: Mortality at 28 days was 22.9% and median serum lactate was 2.9 mmol/L. Intermediate (odds ratio [OR] = 2.05, p = 0.024) and high serum lactate levels (OR = 4.87, p < 0.001) were associated with mortality in the nonshock subgroup. In the shock subgroup, intermediate (OR = 3.27, p = 0.022) and high serum lactate levels (OR = 4.87, p = 0.001) were also associated with mortality. After adjusting for potential confounders, intermediate and high serum lactate levels remained significantly associated with mortality within shock and nonshock strata.Conclusions: Initial serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients admitted to the ED with severe sepsis. Both intermediate and high serum lactate levels were independently associated with mortality. (Crit Care Med 2009; 37:1670-1677)