Early hyperlactataemia in critically ill children
Early hyperlactataemia in critically ill children
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DOI：
10.1007/s001340051155
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发表时间：
2000-03-01
影响因子：
38.9
通讯作者：
Murdoch, IA
中科院分区：
文献类型：
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作者：
Hatherill, M;McIntyre, AG;Murdoch, IA
目的：探讨重症监护儿童早期高乳酸血症、酸中毒、器官衰竭和死亡率之间的关系。设计：前瞻性观察研究。乳酸水平> 2 mmol/l 的儿童有资格参加。术后患者和患有遗传性代谢疾病的患者被排除在外。对 705 名入住重症监护室的儿童进行了筛查，并对 50 名年龄 20.3 个月（0.1-191）患有高乳酸血症（发生率 7%）的儿童进行了登记和随访。记录儿科死亡风险 (PRISM) 评分、多器官系统衰竭 (MOSF) 评分、ICU 住院时间和结果。收集乳酸 (mmol/l)、pH 和碱过量 (BE) 数据，直至入院后 24 小时。数据以中位数（范围）形式报告，并通过 Mann-Whitney、Fisher's Exact 和 Kruskal-Wallis 检验以及趋势卡方检验进行分析。结果：筛查组的总体死亡率为 70/705 (10%)。在研究组 (n = 50) 中，PRISM 评分中位数为 19 (4-49)，MOSF 评分中位数为 2 (1-4)，观察到的死亡率为 32/50 (64%)。幸存者在 ICU 停留的中位时间为 6 天 (2-32)，非幸存者死亡前的中位时间为 3 天 (0-13)。 11 名非幸存者 (34%) 在 24 小时内死亡。在筛查组中，入院时高乳酸血症确定死亡率，似然比 = 15。在研究组中，幸存者和非幸存者之间的入院乳酸（3.8 vs 4.6 mmol/l，P = 0.27）、pH（7.32 vs 7.30，P = 0.6）和BE（-7.5 vs -8，P = 0.45）均无显着差异。入院率和乳酸峰值均未随着 MOSF 评分的增加而增加（P = 0.5 和 0.54）。幸存者的中位乳酸峰值水平为 5 mmol/l (2-9.3)，而非幸存者为 6.8 mmol/l (2.3-22) (P = 0.02)；幸存者的累积平均乳酸水平为 2.4 mmol/l (1-4.9)，而非幸存者为 4.5 mmol/l (1.6-21) (P = 0.0003）。入院后 24 小时持续性高乳酸血症确定了死亡率，似然比 = 7。结论：入院时的高乳酸血症与儿童的高死亡率相关。该组中的非幸存者可以通过峰值乳酸水平或治疗 24 小时后持续的高乳酸血症来区分。
Objective:To examine the relationships between early hyper-lactataemia, acidosis, organ failure, and mortality in children admitted to intensive care.Design: Prospective observational study. Children with lactate levels > 2 mmol/l were eligible for enrolment. Post-operative patients and those with inherited metabolic disease were excluded. Seven hundred and five children admitted to intensive care were screened, and 50 children with hyperlactataemia (incidence 7%), aged 20.3 months (0.1-191) were enrolled and followed up. The Paediatric Risk of Mortality (PRISM) score, Multiorgan System Failure (MOSF) score, length of ICU stay, and outcome were re corded. Data were collected for lactate (mmol/l), pH, and base excess (BE) until 24 h after admission. Data are reported as median (range) and were analysed by the Mann-Whitney, Fisher's Exact, and Kruskal-Wallis tests, and chi-squared test for trend.Results: Overall mortality in the screening group was 70/705 (10%). In the study group (n = 50) median PRISM score was 19 (4-49), median MOSF score 2 (1-4), and observed mortality 32/50 (64 %). Median duration of ICU stay was 6 days (2-32) in survivors, and median time until death 3 days (0-13) in nonsurvivors. Eleven nonsurvivors (34 %) died within 24 h. In the screening group, hyperlactataemia on admission identified mortality with likelihood ratio = 15. In the study group, neither the admission lactate (3.8 vs 4.6 mmol/l, P = 0.27), pH (7.32 vs 7.30, P = 0.6), nor BE (-7.5 vs -8, P = 0.45) differed significantly between survivors and nonsurvivors. Neither the admission nor peak lactate increased with increasing MOSF score (P = 0.5 and 0.54). The median peak lactate level was 5 mmol/l (2-9.3) in survivors compared to 6.8 mmol/l (2.3-22) in nonsurvivors (P = 0.02), and the cumulative average lactate level was 2.4 mmol/l (1-4.9) in survivors, compared to 4.5 mmol/l (1.6-21) in nonsurvivors (P = 0.0003). Persistent hyperlactataemia 24 h after admission identified mortality with likelihood ratio = 7.Conclusion: Hyperlactataemia on admission to intensive care is associated with a high mortality in children. Nonsurvivors within this group may be distinguished by the peak lactate level, or by persistent hyperlactataemia after 24 h of treatment.