Time-pattern of lactate and lactate to pyruvate ratio in the first 24 hours of intensive care emergency admissions
Time-pattern of lactate and lactate to pyruvate ratio in the first 24 hours of intensive care emergency admissions
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DOI：
10.1097/00024382-200014010-00002
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发表时间：
2000-07-01
期刊：
影响因子：
3.1
通讯作者：
Takala, J
中科院分区：
文献类型：
--
作者：
Suistomaa, M;Ruokonen, E;Takala, J
危重患者的血乳酸升高通常被认为是组织灌注受损的标志。乳酸/丙酮酸比值（L/P比值）的同时升高可能有助于区分高乳酸血症的不同机制，从而确定该发现的相关性。我们前瞻性研究了98例连续急诊入院患者的高乳酸血症和同时L/P比值升高的患病率和时间模式。在重症监护室入院的最初24小时内，每隔2小时测量一次血乳酸、L/P比值和血气。48例（49%）患者出现高乳酸血症（血乳酸超过2 mmol/L），死亡患者的中位峰值高于存活患者[分别为5.3（四分位数间距1.9-7.5）vs. 1.9（1.3-2.9）mmol/L，p = 0.003]。入院时高乳酸血症患者（n = 31）的住院死亡率高于入院后高乳酸血症患者（n = 17）（29.0% vs. 5.9%，P = 0.003）。入院时持续性高乳酸血症（>6小时）的死亡率高于短暂性高乳酸血症（36.8% vs. 0%，P = 0.008）。同时L/P比值升高（L/P比值> 18; n = 16）的死亡率高于L/P比值正常的高乳酸血症（n = 32;分别为37.5%vs.12.5%，P = 0.03），主要见于严重循环衰竭患者。脓毒症患者的高乳酸血症与L/P比值升高无关。我们的结论是高乳酸血症是常见的急诊入院患者。高乳酸血症伴L/P比值升高和乳酸酸中毒可能与组织灌注不足有关。高乳酸血症持续6小时以上，同时L/P比值升高，与死亡率增加相关。
Blood lactate elevation in critically ill patients commonly is taken as a sign of impaired tissue perfusion. Simultaneous elevation of lactate to pyruvate ratio (L/P ratio) may be helpful in discriminating between different mechanisms of hyperlactatemia and thus in determining the relevance of the finding, We studied prospectively the prevalence and the time pattern of hyperlactatemia and simultaneous L/P ratio elevation in 98 consecutive emergency admission patients in a 23-bed surgical-medical University Hospital intensive care unit. Blood lactate, L/P ratio, and blood gases were measured at 2-h intervals during the initial 24 h of intensive care unit admission. Hyperlactatemia (blood lactate over 2 mmol/L) was found in 48 (49%) patients, and the median peak value of the non-survivors was higher than that of the survivors [5.3 (interquartile range 1.9-7.5) vs. 1.9 (1.3-2.9) mmol/L, respectively, p = 0.003]. Hyperlactatemia at admission (n = 31) was associated with a higher hospital mortality than hyperlactatemia developing later (n = 17) (29.0% vs. 5.9%, P = 0.003). Sustained admission hyperlactatemia (>6 h) was associated with higher mortality than short-lasting hyperlactatemia (36.8% vs. 0%, P = 0.008). Simultaneously elevated L/P ratio (L/P ratio > 18; n = 16) was associated with higher mortality than hyperlactatemia with normal L/P ratio (n = 32; 37.5% vs. 12.5%, respectively, P = 0.03) and was found mainly in patients who had severe circulatory failure, The hyperlactatemia of patients with sepsis was not associated with L/P ratio elevation. We conclude that hyperlactatemia is common in emergency admission patients. Hyperlactatemia with L/P ratio elevation and lactic acidosis is likely to be associated with inadequate tissue perfusion. Hyperlactatemia persisting more than 6 h and simultaneous elevation of L/P ratio are associated with increased mortality.